To Ice or not to ice - that is the question

There has been debate about the relevance of icing an injury, especially soft tissue injuries like muscle strains, for many years now. We have nearly all heard the acronym RICE (Rest, Ice, Compression, Elevation), but this term was coined back in 1978 by Dr Gabe Mirkin, and has since been replaced 3 times over! (1) Dr Mirkin retracted RICE as a recommendation himself in 2014.
 
So, what is the big deal here? Well, it has been suggested that while cooling will delay swelling and help numb the pain, it will not speed up your recovery. Ultimately, the healing process of the body requires inflammation to heal, and applying ice will cause constriction of the blood vessels and slow the flow of important healing inflammatory cells (macrophages) to the damaged tissue. Even anti-inflammatory medications will delay this healing process! (2)
 
“Great… So, what do I do now?” I hear you ask. Research now tells us that we should not be using the RICE acronym, rather, we should use PEACE & LOVE. (2)
Protection – avoid activities and movements that increase pain during the first few days after injury.
Elevation – elevate the injured limb higher that the heart as often as possible.
Avoid anti-inflammatories – avoid taking anti-inflammatory medications as they reduce tissue healing. Avoid icing.
Compression – use elastic bandage or taping to reduce swelling.
Education – your body knows best. Avoid any unnecessary passive treatments and medical investigations and let nature play its role.
&
Load – let pain guide your gradual return to normal activities. Your body will tell you when it is safe to increase load.
Optimisation – condition your brain for optimal recovery by being confident and positive.
Vascularisation – choose pain free cardiovascular activities to increase blood flow to repairing tissues.
Exercise – restore mobility, strength and proprioception by adopting an active approach to recovery.
 
All of this does not mean you should throw your ice packs away. (3) They are still useful to help reduce swelling, especially for that big ankle sprain. (4) But for the everyday muscle strain or injury, leave it in the fridge.
 

1. Mirkin, G. & Hoffman, M. (1978). The sportsmedicine book. (1st ed.).
2. Dubois, B. & Esculier, J-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54, 72-73.
3. Scott, A., Khan, K. M., et al. (2004). What do we mean by the term “inflammation”? A contemporary basic science update for sports medicine. British Journal of Sports Medicine. 38, 372–380.
4. Palmieri, R. M., Ingersoll, C. D., et al. (2004). Arthrogenic muscle response to a simulated ankle joint effusion. British Journal of Sports Medicine. 38, 26–30.