Does Icing an Injury Delay Healing?

to ice or not to ice
to ice or not to ice.

The physician who coined the acronym "R.I.C.E" in the late 1970s has changed his stance on using ice on a sports injury. Dr. Gabe Mirkin, author of one of the most popular books about sports medicine, wrote a blog post updating his position on the recommendation to use "rest, ice, compression and elevation" for the immediate treatment of sports injuries, such as strains and sprains.

Citing current evidence, Dr. Mirkin writes that it now "appears that both ice and complete rest may delay healing, instead of helping." Until now there has been little evidence to actually support the use of R.I.C.E., but studies have found almost no evidence that icing an injury speeds healing.

Inflammation and Healing

The evidence has found that icing a soft tissue injury will reduce swelling and inflammation, which had been thought to delay healing. Now researchers believe that inflammation is actually a necessary component of proper healing. 

Dr. Mirkin explains that inflammation is similar to the way the immune system attacks other foreign invaders such as germs. When there is damage to the soft tissues—such as muscle pulls, strains or general soreness—the immune system responds by sending inflammatory cells called macrophages to the damaged tissues.

Once there, these cells release IGF-1 (insulin-like growth factor), and this hormone helps the damaged tissues rebuild, repair, and heal. Research indicates that applying ice to the injured area prevents the release of IGF-1 and ultimately, delays healing.

We've known for some time that ice works to reduce pain and swelling. We also know that cold causes blood vessels to constrict. The unwanted side effect of this constriction, however, is that inflammatory cells and their healing hormones are prevented from getting to the injured tissues.

Dr. Mirkin points out that once these blood vessels are restricted, they stay closed for hours. The lack of circulation can result in tissue death and may actually cause permanent nerve damage.

Dr. Mirkin also argues that anything athletes do to reduce inflammation delays healing. That includes taking inflammatory or cortisone-types of medicines, using ice or other cold packs, and anything else that stops or blocks the immune system's natural response to an injury.

Should You Ever Ice an Injury?

The main benefit of icing an injury is to help control or reduce pain. That may seem like a good thing. However, Dr. Mirkin says that icing for any more than 5 minutes is detrimental to tissue repair, and can also reduce strength, flexibility, and endurance.

If you use ice for pain management, use it no more than 5 minutes, and remove it for a minimum of 20 minutes before reapplying. According to Dr. Mirkin, there is no reason (or benefit) to apply ice to an injury more than six hours after the initial incident.

Other physical therapists agree, at least that the main benefit of ice is pain relief, and that ice should be applied immediately after an injury and for a short period of time only. There is limited research on the effectiveness of both heat and cold therapy.

One small study found no difference in outcomes in patients with ankle injury who received no ice, or ice and compression, or ice without compression. Another study of ankle injuries found better results with only a brace, vs. treatment with ice, elevation, pain relief, and restricted movement of the joint.

Researchers continue to study the best way to deal with soft tissue injuries and the jury is still out on the most effective treatments. Compression and elevation of an injury may still be appropriate and helpful. Neither action completely stops the release of IGF-1, so the immune response is still able to do its job, yet compression can help manage excessive swelling, which is often one culprit in causing pain.

Still, many experts advise that treatment should be tailored to the athlete. Functional rehab and balance training may be more effective than immobilization, particularly when in managing grade I and II ankle sprains

A Word From Verywell

As an athlete, it's important to pay attention to any warning signs your body sends, and avoid injury if you can. Preventive measures such as exercising within your physical limits and using protective gear are crucial. If you do sustain a sports injury, it's important to stop playing and have a medical evaluation to determine the extent of the injury and begin the rehab process quickly. 

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