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Should you still use ice for acute injuries?

Updated: Jul 12, 2023

Why do we instinctively ask for ice when we injure ourselves? For years and years, doctors, trainers and coaches have recommended “RICE”- rest, ice, compression, elevation. This acronym first came about in 1978 by Dr Gabe Mirkin. His intention behind ice was to minimise the inflammatory response in an attempt to accelerate the healing process.

But why did it change to POLICE? Newer research has found that “Optimal Loading” (OL) helps recovery through cell regeneration induced by safe and light loading in the early stages of injury. They also found that “Rest” (R), or a lack of movement actually prolonged recovery.

What about Ice?


This principle has become so engrained within the sports medicine world, it is often just accepted as best practice. However, Dr. Mirkins himself, who invented RICE has retracted his statement, saying, “it now appears that both ice and complete rest may delay healing, instead of helping”.


While there is a general consensus across research that ice can have an excellent analgesic (pain numbing) effect, the impact of the under-lying muscles is non-existent as muscle temperatures do not change from topical ice application.


We have to remember that swelling and inflammation is a NORMAL process of healing. Without the initial inflammation, injuries do not heal as well, or as fast as they could. This is because it prevents the natural release of signals required to release cells responsible for killing off damaged tissue.


A new acronym was introduced in 2019: PEACE & LOVE (Protection, Elevation, Avoid anti- inflammatory drugs, Compression, Education & Load Optimism, Vascularisation and Exercise.

Now that we know rest is harmful, we want to activate the lymphatic system to assist in clearing waste products and excess fluids from the injured sites. To do this, we must MOVE to achieve muscle contraction and to stimulate repair and remodelling of the injured tissue.


While acute inflammation is necessary and normal, we have to keep in mind that prolonged and over-inflammation can be harmful to healing.


Although the evidence at the moment is inconclusive, there seems to be a trend away from ice with the new emerging evidence. What we do know is that the new acronym proposed as best practice for acute injuries is now “PEAVE & LOVE”.


References


Dubois, B., & Esculier, J.F. (2020). Soft- tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54,72-73.


Caswell, D. (2020). The Truth About Icing Injuries. Retrieved from https://theprehabguys.com/the-truth-about-icing-injuries/


Bleakley, C.M., Glasgow, P., MacAuley, D.C. (2012) PRICE needs updating, should we call the POLICE?. British Journal of Sports Medicine. 46:220-221.


Khan, K.M., Scott, A. (2009) Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine. 43:247-52


Singh, D.P., Barani Lonbani, Z., Woodruff, M.A, et al., (2017) Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol. 8:93


Tidball, J. (2017). Regulation of muscle growth and regeneration by the immune system. Nature Reviews Immunology, 17(3), 165-178


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