We live in a time of change where technology is allowing us to investigate things that were previously just conjecture yet have became part of our collective understanding. Ice for injuries is one such issue that is finally being tested for its effectiveness and is proving to be controversial.
Dr Gabe Mirkin first published a book in 1978 that promoted the idea of the RICE protocol - Rest, Ice, Compression, Elevation - and it took hold immediately. This protocol is known by just about everyone. If you get injured you ice it. . . don’t you? Even Dr Mirkin has made some retractions!
Research now suggests that ice could slow your healing by inhibiting a hormone called Insulin Growth Factor 1 (IGF-1). This grown hormone is essential to the healing process. So it turns out that anything that reduces swelling also slows healing. That includes Anti-inflammatory drugs like Ibuprofen.
Now it’s easy to throw the baby out with the bath water on this one and I’ve read many an article online doing just that. Because ice reduces inflammation and therefore IGF-1 the obvious protocol should be “don’t ice, ever”. But that isn’t the whole story.
Ice, whilst great at restricting inflammation, is also a painkiller - an analgesic. So the question is, what are you using ice for? To reduce inflammation or reduce the pain.
Ice is still widely used for several weeks after knee replacement surgery. Surely that would slow the healing rate? Well we have to consider how painful an operation like this can be. Ice is fantastic at reducing pain, which means the patient can get up and moving faster, which is the most beneficial thing any of us can do in the early stages of healing. So we can forgo a little recovery speed in the pursuit of getting mobile again post-op.
Killing pain also helps us to get our confidence back and see that things are progressing. The psychology behind pain is proving to be the most important aspect of stopping pain from becoming chronic. So again, ice is useful.
So what should you do - ice or not? Here are my Dos and Don’ts for ice protocol.
Do ice for comfort: If the injury is painful and you are struggling to bear any weight then ice might help with that. You’ll need to accept that healing may take a little longer but it is better to get pain under control first, then heal later.
Don’t ice for too long: Ice can reduce pain in a few minutes but doesn’t chill the whole area and restrict blood flow for a little longer. Reducing pain by a few percent can make life tolerable. You don’t always need to numb the pain completely. So finding the sweet spot where pain decreases a little but doesn’t restrict blood flow can be ideal. A good measure for when you’ve gone too long is that the skin will become very pale and then go red if you ice even longer. The skin should still be reasonably similar in colour to surrounding tissues (just a little paler) and the pain is hopefully slightly reduced at the point when you should stop. You can always go again an hour or so later.
Although research is changing the way we think about injury recovery (in many areas) we still have to do what we feel is right for us at the time. Pain is just as much an issue of recovery as healing time is. Healing a little slower and having less pain may be the right path for some people, whilst the opposite might be true for others. If you want to get back to activity faster, then I might suggest you don’t ice and put up with the discomfort. If things aren’t so urgent you might want to take the less painful approach. We can discuss this in detail and build you a personal plan in our appointments together.