Is Ice the Best Treatment

By Brittney Lang, MS, ATC, SCAT
Athletic Trainer
MUSC Health Sports Medicine

For many years it has been the standard to use ice for treatment when it came to an injury. Rest, Ice, Compression and Elevation (RICE) has been taught and instilled in many healthcare professionals. Recently some studies have shown that ice may not be the best treatment for an acute injury.

Back in the 70s, Dr. Mirkin essentially coined the term R.I.C.E. and has been a precedent for treatment protocol since for sprains and strains and other acute injuries. Icing an acute injury is said to delay inflammation and help reduce pain. Studies have shown success with this treatment for many years. Many healthcare professionals still use ice as initial treatment for an acute injury to combat inflammation and pain.

But more recently some studies have shown that maybe the “ice” portion of the acronym may not be the best treatment protocol. We know there is a process the body goes through when an injury occurs. These phases of healing are: injury, inflammation, repair and remodeling. Using ice during the initial onset is claimed to hinder the necessary inflammation portion and possibly causing more metabolic build up and edema. During inflammation the blood vessels are dilated which increases blood flow causing swelling and warmth to the touch. During this time necessary proteins, cells and chemicals from the body are released to help activate inflammation to start the healing process. If ice is used for treatment during this phase it is decreasing blood flow and thereby decreasing the healing. Dr. Mirkin now recommends skipping ice altogether unless they have significant pain; then should only be used a few times, for 15-20 minutes, over the first 24-48 hour period. Other treatment options are used as well to help with healing and recovery during this time as well.

While physiologic research does present convincing evidence, there have not been enough studies done with direct evidence proving that ice used for an acute injury hinders inflammation during the healing process. After the initial 48 hours after an injury, using ice will not do much for reducing swelling but is more for pain reduction. Ice has been shown to be an effective and safe method for pain management. It may be better utilized during the recovery process with exercise and other therapeutic systems to improve healing by allowing the athlete to start rehabilitation earlier.

Ice can sometimes be overused and claims can be made that may or may not be completely true. There are definitely times when ice is not recommended for treatment. But there is just not enough research currently that definitively proves when ice should or should not be used in relation to acute injuries and whether it impedes the healing process. Until ice is proven to have a direct impact on the healing process, then it will continue to be the standard method for treatment for acute injuries. It is up to the discretion of the healthcare provider and what they feel may be the best course of action to treat the acute injury; and what they have seen to show results with the recovery and return to activity for the athlete. Our job as healthcare providers is to make sure we are doing our own research and advancing our knowledge base, to help us treat our patients and to have the best outcomes possible.