Since the 1970’s we have been following the suggestion of Dr Gabe Mirkin, a physician who had the initial idea of using ice on acute injuries as a way of controlling inflammation. This sounds good in theory – the less inflammation, the faster the body will recover and heal right? This idea grew into the popular acronym RICE that most people are familiar with today.
R – Rest
I – Ice
C – Compression
E – Elevation
But as further research was conducted, we realised rest was actually not ideal for cell recovery. Instead, Optimal Loading through gentle and sensible mechanical loading led to a better outcome. This resulted in RICE being converted into POLICE.
P – Protection
O – Optimal
L – Loading
I – Ice
C – Compression
E – Elevation
With rest no longer being best practice, it forced a re-evaluation of the other strategies being continually recommended. So what about ice?
There is no doubt that ice is a great pain reliever. The cooling of the skin helps to dampen down the pain response, but there is no evidence that ice can actually change the temperature within the muscle. It just can’t penetrate that deeply.
Furthermore, we now know that an inflammatory response is actually essential to the healing process. Post-injury our body sends signals to cells, which then release the hormone “insulin-like Growth Factor” (IGF-1). IGF-1 assists with healing by killing off damaged tissue, so that new tissue can be generated. Application of ice may interfere with the release of IGF-1, potentially delaying the commencement of healing.
Ice was subsequently removed from the acronym, and in 2019 it was redeveloped further into PEACE & LOVE
P – Protection
E – Elevation
A – Avoid anti-inflammatory drugs
C – Compression
E – Education
&
L – Load
O – Optimally
V – Vascularisation
E – Exercise
So should we continue to use ice if it makes us feel nice? Despite the effect on pain, ice is now not recommended for mild to moderate injuries. Where ice may be beneficial, is in more severe injuries, where the inflammatory response is out of control. The development of too much swelling and inflammation can put increased pressure on tissue and impair mobility and muscle function. In the cases of severe joint/ligament sprains (e.g. lateral ankle sprain, ACL ruptures) ice could be a good modality to both limit pain as well as inflammation.
So although ice is nice, motion is lotion and we should be focusing on getting people moving again as quickly (and safely) as possible.
