Clapham Manual Therapy and Functional Movement

The Cons of Icing Injuries

icing ankleFollowing on from last month’s blog post about the benefits of cold water swimming, I want to talk a little about the common habit of icing injuries. I have recently become less convinced that the ongoing use of ice following a soft tissue injury is a good idea. You are probably familiar with the use of ice to control local inflammation following an injury. In fact ‘Rest Ice Compression Elevation (RICE)’ is considered by most to be the gold standard treatment when they have pulled a muscle or sprained an ankle, along with popping a few NSAIDs.  However, whilst this approach may relieve the pain from injured tissue, it actually slows the healing process.

Inflammation at an injury site is completely normal, it is the first step of the physiological healing process. It allows for the cells and materials that are used in repair to reach the injury site with an enhanced circulation. The waste products are then removed via the lymphatic system.  Icing slows these systems down.  It is like trying to get building work done on your house and then putting in place emergency roadworks in the area so that the builder’s delivery and removal vans cannot reach you.

Many believe that icing reduces the painful swelling.  However, in reality, the excessive swelling is not because of the increased circulation to the area, but more because the lymphatic drainage is slowed. Lymph drainage is essential to return fluid from the body’s tissues back to the circulatory system.  When there is an injury causing more fluid to leak out of the capillaries into the tissues it becomes even more important.  The system relies on muscular contraction to work, so if you are resting the area, as well as using ice, this will stop the drainage and possibly allow the system to backflow and so increase the local swelling.  This effect will be increased by the use of anti-inflammatory pain medication such as ibuprofen or naproxen.

So What Should You Do?

First, you want to stop exercising and assess the situation. Depending on the injury, you may need to seek medical attention to check for bone fractures or other serious damage.  If, however, it is determined that the injury is limited to soft tissue, then the use of elevation of the injury and a compression bandage would be helpful. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injury for short periods soon after it happens. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10-minute application once or twice, but after that initial period, there is little benefit to ice. In fact, some studies are now showing that intermittent heat is more beneficial as it increases the circulation to the area. Also, try to avoid the use of NSAIDs unless absolutely necessary as they will impair the healing process.

The most important tools are elevation, compression and frequent gentle mobilisation of the area within the pain-free range. For example, with a sprained ankle, doing pain-free ankle circles or just wiggling the toes if that is too much.  To be clear, mobilisation does not mean loading the area if it is painful, so the advice would still be to try and stay off a sprained ankle until it feels OK to walk on. By following this advice you will be enhancing your body’s self-healing mechanisms. In fact, the acronym “RICE” should be replaced by “MCE” – Mobilisation, Compression and Elevation.  

If you need help managing or rehabilitating your injury, get in touch with us at Backs Etc.  We can help you get back to what you love doing as fast as possible.