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To ice or not to ice ??

Are we doing more harm than good by reaching for the ice pack ?




It used to be a common sight to see a Premiership footballer rolling around in agony on the pitch, clutching their ankle and the medics running on with the ice bucket, slapping on the old frozen Magic Sponge and........ Hey Presto ! They are up on their feet ! Springing around Old Trafford like a gazelle ! Indeed applying ice for a sporting injury like a sprained ankle or twisted knee has been used since the 1970's and when it came to treating acute, fresh injuries the anacronym R.I.C.Ewas coined by the sporting medical fraternity :

R = Rest, I = Ice, C = Compression, E = Elevation.

Over the years this anacronym has been added to and modified and has gone through all sorts of changes ( It became P.R.I.C.E. at one stage with P = Protection being bolted on ) but ' Ice ' was always included as part of the package...... until 2019 when it was dropped from the anacronym altogether. Why ??


Well mostly because we now know a lot more about the healing process and the best way of encouraging it and, well, ice isn't the superhero treatment it was once seen as.


So why was Ice used ?


The original theory was that applying ice would reduce any inflammation and speed up healing of the damaged tissues. Any bleeding into the tissues would be minimised and the healing process would be hastened. The only snag is that inflammation is actually a very necessary part of the healing process. Stimulation of the inflammatory cells engourages damaged tissue to be removed, clearing and preparing the ground for new tissue to be laid down and complete the healing process. Basically the ice gets in the way of Mother Nature doing her job and does the exact reverse of it's intentions. In fact we now know both Rest and Ice are actually detrimental for healing and delay healing of damaged tissue. Tissues need a little bit of load and stress going through them to encourage healing and help build a strong, supple scar.


So should Ice be used at all ?


It really comes back to the reason WHY the ice is being used.


As a pain reliever there is no doubt that ice does a great job in the short term - which is probably why you sometimes still see it being used in a sporting environment. - and indeed many patients find it's helpful to help numb the area and provide pain relief, however brief.

But, it could be argued that these temporary benefits don't outweigh the detrimental affects on healing. In the long term I would advise to hold the ice. Maybe a painkiller is actually a better option. ( Not anti-inflammatory like Ibuprofen though ! But that's another blog for another day ! )



There's always an exception.......


All is not lost for those fans of ice - the one situation where it is very useful is to limit excessive swelling such as that seen after a fracture or severely sprained ankles .... you know, those ones that go black and blue and swell to elephantine sizes with everyone saying " ooh you really ought to get that X-rayed " In this case the swelling causes problems of it's own as it stretches the tissues, limits movement and inhibits muscle function and there is more of a case for ice to be used alongside compression to reduce the swelling. But these are the kind of injuries that generally knock people off their feet with weightbearing being significantly impacted a nd medical help usually being sought. The right advuce will be given in these instances.


Oh and the anacronym today ?? It is PEACE & LOVE

Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularisation and Exercise


Good luck remembering that one :)

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