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RICE - To Ice or Not Ice

There have been some recent media reports about ice not being as useful, or indeed impeding healing, after an acute injury. We have been using ice as an analgesic for much longer than I have been a physio and the treatment regimen of RICE (Rest, Ice, Compression, Elevation) in the early stages of an acute injury, be it from sport, work or leisure.

The Sydney Morning Herald article on this quoted "Cold and ice are safe pain medicines, but they delay healing."

There is apparently some evidence (and we should rely on evidence in Physiotherapy Practice) that using ice actually delays healing, because it constricts the blood vessels and reduces the amount of inflammation at the injury site. How much does it reduce healing? That certainly hasn't been quantified. Is the delay in healing greater than the delay to get moving created by a swollen painful ankle?

But isn't reducing inflammation a good thing? Not if it brings the good healing bits to the injury site.

Does the body produce more inflammation than is necessary? Quite possibly, and that would be good reason to use ice!

The key for me is that if ice is a good analgesic and its relatively safe, surely a reduction in pain is a good thing. A reduction in pain is also more likely to enable earlier range of motion and weight bearing - key components in the rehabilitation process. And ice is certainly a lot safer than using opioid drugs.

Whilst its a good analgesic, ice is pretty insignificant in reducing inflammation. certainly nowhere near as effective as Non Steroidal Anti Inflammatory drugs like Voltaren.

Using some ice, or a bucket of cold water for 10-20 minutes may indeed create a temporary reduction in blood flow and therefore a temporary reduction of inflammation, but when it comes to impeding or affecting the natural inflammatory processes its simply insignificant in the grand scheme of things.

Applying an ice pack to something that hurts is a simple, cheap and more importantly safe method of analgesia, and for that, it should be promoted and used more than it is.

So how should we treat an acute injury.

REST - but only from things that aggravate the injury or could potentially make it worse

ICE - in the early stage to help reduce pain

MOBILISATION - active mobilisation the injured area to prevent muscle wasting and loss of range of motion

Most of all, get in to see one of our Physios, to get the right advice and management plan.

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