Should we be applying ice after an acute injury?
Growing evidence says - no way.
All of these years as a massage therapist, I've been advising clients to apply RICE ( an acronym for Rest, Ice, Compression and Elevation ) following an acute injury to minimize pain and inflammation.
Today, many health professionals are questioning if the application of ice does more harm than good when healing from an injury.
Icing an injury is a relatively new concept and used predominantly in North America. Traditional Chinese and Ayurvedic Medicine believe that icing an area after injury is counterproductive to proper healing and tissue repair.
If we interfere with the process of initial inflammation, how does that effect the stages of tissue repair that follow?
The 3 stages of healing and tissue repair are inflammation followed by proliferation (laying down of new tissue fibres) and remodelling (forming new tissue from regenerative cells).
Inflammation following acute injury has the benefit of mobilizing an area of injury to avoid further damage. Vasodilation (dilation of blood vessels) floods the area with fresh blood containing white blood cells (macrophages and leukocytes) which clean up the area of metabolic waste and flush out foreign invaders such as bacteria from the site.1
How then, does the body rid itself of inflammation?
Luckily, we are biologically engineered with an entire system of vessels, ducts and transportation routes designed to move inflammation away from a damaged area.
The lymphatic system is an extraordinary network designed to move inflammation and toxins and flush what we no longer need out of our bodies through urine, sweat and mucous.
"Inflammation of an injury is the body's natural response - the body's mechanism for immobilizing an injury. The swelling is the body trying to pump blood and nutrients to the injured area and also draw away the bad blood, explains Dr. Kelly Starrett, Doctor of Physiotherapy, mobility and performance expert.
The numbing effect by the ice also cuts off the connection from the brain, and thus preventing the recovery or the brain's ability to send hormones to help with the healing process," notes Starrett.2
During an experimental study conducted using rats (Takagi et al 2011),
"the muscle belly of the extensor digitorum longus of anaesthetized rats was crushed for 30 seconds using forceps. Immediately after the injury the rats were randomly divided into two groups, the no icing group and icing groupwhere they placed fine crushed ice in a tiny polyethylene bag on their injured hind leg for 20 minutes." 3
The rats were microscopically examined after 1 - 12 hours and 3 - 4 days and they found that the group that did not receive ice to their injuries, experienced an increase in white blood cells to the area, an increase in regenerating muscle cells present at Day 3 and normal maturation of regenerating muscle fibres.
The second group that received a 20 minute application of ice had less macrophages than the first group, reduced and smaller sized regenerating muscle cells at Days 3 and 4 and maturation of regenerating muscle fibres was significantly reduced over the group that did not receive ice.
What do we know for sure?
Rest, compression and elevation are still mandatory in the case of acute injury. They all work to repair tissue and get the body back to normal function.