Ice No Longer NICE
In the space of soft tissue (muscle, ligament, tendon, nerves, etc.) healing and recovery, the use of ice has been left in the rear-view mirror. A treatment modality that used to be front line after spraining an ankle or an achy back from yard work, is now dispelled regarding its effectiveness. In fact, the use of ice after a minor injury such as the ankle sprain or achy back, has been shown to create barriers to recovery. The reason being is that after you’ve injured yourself, the area that has been injured will be congested with inflammation and other breakdown products from the injury. The last thing you want to do is apply something like ice which will constrict the blood vessels around the area and lock in all the congestion. By constricting the blood vessels, you are also constricting the flow of new blood which consists of oxygen, nutrients, and other cells that help to clean up the damaged tissue.
But what about limiting inflammation?
That’s the most common reason people give for using ice after an injury. However, the inflammatory process is a natural process that MUST occur for the injury to properly heal (These steps include: Hemostasis, Inflammation, Proliferation, Maturation). By applying ice and delaying that process, you will only be delaying the inevitable timeline of healing. So not only does icing delay normal onset of healing, but it can also create more damage to the injured area. When you apply an ice pack to an injury (i.e. elbow or knee) the ice pack is often much larger than the injured tissue area. The cooling effect of the ice pack will start to cool otherwise healthy superficial skin layers surrounding the area of injury. A drop in skin temperature of only 0.5 degrees celsius has been shown to slow metabolism and start to starve healthy tissue.
So, why do I feel better after my ice bath?
A loaded topic for discussion reserved for another post. But the best information currently available shows ice influences dopamine levels in our brain giving us a surge of accomplishment and happiness after its use. The psychological benefit must be weighed with the deleterious physical effects on our body and tissues.
So when should I use ice?
Well in the scenario of a completely severed limb it would be useful. But also, in specific instances such as acute bursitis, facial damage, and acute concussion ice can be beneficial. We aren’t discounting the positive effects that ice can have on ALL instances, we are just ensuring it’s widespread use is limited unless specifically indicated in such cases as seen above.
So what’s the protocol if we’re no longer ice?
The British Journal of Sports Medicine has coined a new acronym named “PEACE & LOVE” to help us better understand how to deal with soft tissue injuries. See the image below for full details on what this acronym stands for.
BJSM Peace and Love acronym for soft tissue healing. Notice that icing is not mentioned?
The cover of the Boston Globe in 1962 depicting the first successful re-attachment of a limb following complete severance. The beginning of the “Ice Age”.
Where did the idea of ice come from?
Back in the 1960’s is when ice really gained its fame and fortune with injuries. It was proven to be very effective in the scenario of a young boy who severed his arm off while joy-riding on a train in Massachussets. In that scenario, the surgeon instructed the young boy’s parents to ensure their son was relaxed under a tree away from the sun (REST), position the severed limb on a bed of ice as he remembered the local fish market does to limit decay (ICE), tie a tourniquet above the severed region (COMPRESSION), and position the limb above his chest (ELEVATE). From there, the acronym RICE was born. The parents followed these steps and the surgeon, Dr. Ronald Malt, was able to successfully reattach the first fully severed limb in history.
Dr. Malt has been on record numerous times in saying that based on how this story was reported, the use of ice has been recklessly utilized. Ice wasn’t a part of medical protocol before this incident in 1962 and unfortunately became a mainstay afterward as many misinterpreted its usefulness. Dr. Malt passed in 2017 but was a heavy advocate for limiting the use of ice when it comes to soft tissue injury and recovery.
References
Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.
Scialoia, Domenic, and A. Swartzendruber. "The RICE protocol is a myth: a review and recommendations." The Sport Journal 19 (2020).
