Applying ice (cold therapy) after an injury to reduce pain and limit swelling has been a common practice, and using ice for physical therapy used to be common, too.
The RICE (rest, ice, compression, and elevation) protocol has been around since the 1970s and directed the application of ice to acute injuries. If you sprained an ankle, whacked your thumb with a hammer, pulled a muscle, or experienced soreness after an intense workout, you would apply ice. However, it turns out that applying ice to injuries is not a good idea.
The Science Behind Healing
When the body suffers an injury, the natural healing response includes swelling (inflammation). Swelling is the result of the body’s healing response. During the healing process the body:
- Uses the circulatory system to deliver oxygen and key nutrients to the injury via blood to support cellular repair and tissue regeneration.
- Also increases circulation to help remove waste products from the damaged tissue.
- Delivers white blood cells to the injury to stave off infection.
Inflammation is vital to the healing process.
Why Icing an Injury Hampers Healing
Icing an injury restricts, slows, and delays this essential part of the natural healing process. When exposed to cold, the body naturally constricts its blood vessels to slow the flow of blood and conserve body heat. As a result, icing an injury constricts the blood vessels and decreases blood flow to the injury. While this reduces swelling around the injury and numbs pain, it does so by reducing vital circulation, delaying the healing process.
Alternatives to Ice for Physical Therapy
Due to the negative impact of cold therapy on healing, the RICE protocol has been replaced with MEAT, which stands for:
- Movement - Gentle and safe (physical-therapist-assisted) movement can help ease pain and promote healing through improved lymphatic drainage. This removes waste from the injury while promoting circulation. This movement typically includes a pain-free range of motion.
- Exercise - Exercise gently focuses on increasing strength and range of motion while triggering healing at a cellular level. Exercise uses gentle resistance to gradually extend the individual’s range of motion.
- Analgesia - Pain medications can be used, as recommended or prescribed by a healthcare provider to ease pain during the healing process. Non-steroidal anti-inflammatory (NSAID) medications are the most common medications used for pain relief from soft tissue injuries.
- Treatment - Diagnosing and addressing the underlying issue that is causing musculoskeletal pain is the final step in providing lasting relief. Treatment can include a wide array of modalities and therapeutic interventions that vary based on the underlying condition.
In addition to MEAT, compression and elevation (the C and E of “RICE”) can still also be used to support acute soft tissue injuries by better regulating circulation and fluid accumulation.
In addition to following proper care and treatment protocols, patients should also focus on staying hydrated (drinking plenty of water while avoiding caffeine, excessive salt, and alcohol) in addition to eating a healthy, balanced diet to support circulation and provide plenty of healing nutrients.
When Ice May Be Useful
Although prolonged ice application has been shown to delay and slow the healing process, it does offer some benefits. When applied during the first 24 to 48 hours after an injury, ice can help alleviate pain.
Ice should only be applied, as instructed by a healthcare professional. Typically, ice application includes the following recommendations:
- Always wrap ice or a cold pack in a towel or cloth to protect your soft tissues from frostbite.
- Apply for no longer than 10 to 20 minutes at a time to avoid nerve damage.
- Allow at least 30 minutes between ice applications so that your skin and soft tissues can warm up again.
- Keep your injury elevated above your heart while you ice.
Protocols for cold therapy vary depending on the patient, the type of trauma (injury or surgery), the patient’s goals (pain reduction vs. accelerated healing), and the overall treatment plan.
Evidence-Based Recovery With Fyzical Therapy & Balance Centers
At Fyzical, we always emphasize the importance of using evidence-based recovery protocols, therapeutic modalities, and treatment recommendations. To learn more about the best way to recover from an injury or surgery, we welcome you to contact us to schedule an appointment for a consultation with a physical therapist.