I had a conversation with a coach earlier this year who was asking me about ice. He had conversations with other coaches who had read the book, Iced by Gary Reinl, and he wanted my opinion. Since I have not read the book, I felt that in order to give an informed opinion I should do some research. I looked at an interview with Gary about his take on ice and then searched medical journals to see whether ice had been tested and what the outcomes were. I was a little surprised at the lack of research specifically studying ice in its many prescribed applications.
In school, we are taught ice has an effect on the inflammation process. The inflammation process is a problem and should be decreased as soon as possible in order to speed recovery. When tissue is damaged, the body sends microorganisms to the injury site to fight the inflammation and part of that process is tissue swelling. Ice helps to decrease the blood flow to the area in order to slow this process down. One of the main arguments against ice in the acute inflammatory process is that this inflammation is actually beneficial to the body. Inflammation is the body’s way of breaking down tissue and laying the groundwork for recovery. An interruption to this process can be potentially detrimental.
Acute sprains: Ice has been the mainstay of treatment, along with the remaining letters of the acronym, RICE (also known as rest, ice, compression and elevation), for years. When I reviewed the effectiveness of RICE on outcomes, there are very few well controlled studies. The main conclusion is more needs to be done to study the effect of RICE on treatment outcomes and return–to-play decisions.
Pain control: Ice has an analgesic effect on injuries. Applying ice to an acute injury can help to decrease the pain associated with the injury in the first couple of days. Ice does appear to aid in recovery during the first 48 hours post-surgery.
Tendon injuries: Chronic tendon injuries are characterized by a breakdown and a change in the tendon itself, without the presence of inflammation. Ice is used for pain associated with the condition but should not be used for inflammation.
Delayed onset muscle soreness (DOMS): Ice may have an effect on the pain associated with DOMS as a result of activity, but it does not shorten the time of discomfort. The main treatment for DOMS is light exercise.
During the course of the research, I learned rest and immobilization can cause the collagen fibers that repair an injury to align themselves in a haphazard manner. Moving the joint post injury can get these fibers into better alignment. I want to stress this is for sprains and strains and not fractures or dislocations, which need different management. It appears immobilization for a day followed by movement can also help improve healing in the hamstrings for injuries that are more significant than a mild strain.
In light of this research review, I will make some changes in how I recommend athletes manage an injury.
- I will recommend ice as a pain modifying treatment to be used for 10 minutes to decrease pain in the first 48 hours following an injury and to move the joint as they are able.
- I will still recommend compression and elevation for swelling in conjunction with movement.
- I will recommend that athletes lightly exercise if they are sore.
- For chronic conditions, I will recommend soft tissue work and eccentric exercise.