It is almost humorous that one of the easiest home care methods is also one of the most controversial in its application. From the standard R.I.C.E. to “Ice is for dead people” there are a lot of opinions on whether or not the application of cold for pain and injury is beneficial or just bad advice. In my own education, my opinions have changed over the years (as they should when science says to). That being said, there is still a lot of misinformation out there. The goal here is to present evidence- based information to help you decide whether or not to reach for that ice pack.
It is very common for people to say that ice is useful for acute injuries, but not for chronic ones. A 2017 study by Singh et al., used rats to test the tissue response to ice application following acute injuries. Results showed that after 3 days, the rats that were using sham ice had healed more tissue than that of the rats that received ice. The conclusion of the authors however, was that icing delayed the infiltration of inflammatory cells, but did not necessarily decrease actual healing time or quality. They also noted further research was need to assess if icing the injury more frequently changed the outcome. These results do not necessarily bode well for icing, but does not entirely discredit it either.
A 2012 A 2012 meta-analysis by Van den Bekerom et al, looked at the use of R.I.C.E. (rest, ice, compression, and elevation) in ankle sprains. Once again research showed to be inconclusive on the effects of ice. Authors reviewed 24 studies and noted that none of them sufficiently showed that ice was effective for the use of R.I.C.E. as a treatment for ankle sprain. Instead they found that the recommendation as a treatment should be made on a case by case basis by licensed professionals. That statement, while indecisive, does have validity in the sense that treating a patient as they come in is important.
Another study on different icing protocols in acute ankle sprain was published in the British Journal of Sports Medicine. This study showed that the use of intermittent icing lead to a better decrease in pain over a ‘standard protocol’. The ‘standard protocol’ in the study was defined as icing for 20 mins, whereas the intermittent protocol involved icing for 10 minutes, not icing for 10 minutes, then 10 minutes icing again. Results showed there was still not a shortening of healing time from this treatment. So, what can we conclude from all of these studies together?
The argument of ice effectiveness is an ongoing discussion that will take longer to truly identify. Will icing be harmful to an injury? It appears that is unlikely. It also appears that it is unlikely that ice will expedite healing time. Should ice be used at all? I tend to agree with the conclusions of Van Den Bekerom et al, that it all depends on the case. Many people want nothing to do with ice and I happily encourage them to avoid it. If a patient really leans towards icing injuries, perhaps the best advice is to use the intermittent protocol and note that it may help with pain.
The next big question is, what about using contrast hydrotherapy or ice baths as preventative care? Recovery from exercise is perhaps as popular a topic as how to best treat injuries. So, what does research say about immersion? Check back next week to find out!
References:
Singh et al https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339266/
Van den Bekerom https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/