Ice Ice Maybe?
Have you ever hurt yourself playing sport and made sure to slap an ice pack on that injury as soon as you can.
Have you ever stopped to think about why we do that?
Ice is the topic of plenty of debate currently in the sports medicine world. This blog will unpack some of the reasons why we have always iced, and potentially why we should not ice absolutely every injury straight away.
When and why did we start icing?
In 1978, Dr. Gabe Mirkin introduced the RICE protocol (Rest, Ice, Compression, Elevation) to treat acute injuries, emphasising ice to reduce inflammation and speed up healing. This protocol evolved into PRICE (adding Protection) and later POLICE (replacing Rest with Optimal Loading) as research highlighted the benefits of early movement. The introduction of Optimal Loading marked a significant shift, recognizing that light mechanical loading in the early stages of recovery promotes cell regeneration, making prolonged rest detrimental.
Reevaluating Ice
While ice effectively numbs pain by cooling the skin, its impact on deeper muscle tissue is negligible. In 2014, Dr. Mirkin retracted his support for ice, acknowledging that it could delay healing by inhibiting the release of Insulin-like Growth Factor (IGF-1), which is crucial for tissue repair. The body's natural inflammatory response, facilitated by macrophages releasing IGF-1, is essential for initiating the healing process. Applying ice may hinder this natural response, potentially delaying recovery.
Current Protocols: PEACE & LOVE
The latest protocol, PEACE & LOVE (Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularization, Exercise), introduced in 2019, omits ice, focusing instead on a movement and vascularization based approach for optimal recovery. This comprehensive approach emphasises the importance of educating patients about their injuries, maintaining a positive outlook, and gradually reintroducing movement and exercise to facilitate healing.
So, what now?
Despite these changes in our knowledge of optimal recovery, Ice remains useful in cases of severe swelling, such as significant ligament sprains or post-surgery, where swelling will or can hinder recovery. Excessive edema can restrict active range of movement, increase joint stiffness, increase pain, and limit muscle function. In these instances, using ice to limit swelling can be beneficial in the early stages of injury management. However, for most injuries, early and safe movement should be the primary focus, as it encourages circulation, reduces stiffness, and ultimately promotes healing.
Ultimately, understanding the evolving evidence allows for more effective injury management, aligning treatment with the body's natural healing processes and optimising outcomes for patients.
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