Warmth or Ice?
Have you ever wondered about whether you should apply heat or ice when experiencing a musculoskeletal injury? For years we’ve followed the recommendations set out by the acronym ‘RICE’ (Rest + Ice + Compression + Elevate). This recommendation was developed by a Sports Doctor named Gabe Mirkin in 1978 and is now a little outdated.
These days, there has been a shift in thinking, thanks to emerging evidence and advice published by the British Journal of Sports Medicine.
Whilst swelling and pain can be uncomfortable, it has been shown that allowing inflammation to run its course naturally is more beneficial than using ice and anti-inflammatories. In fact, pain and swelling act as red flags for the body to recognise pain and encourage protection of the injured site. This prevents us putting too much of a load on the injury too soon.
Enabling this process leads to the following to happen:
- Dilation of blood vessels; which enables healing through the delivery of essential components and removal of debris.
- Ensures adequate lymphatic flow to and from the site of injury, which means more neutrophils and macrophages can access the injured site.
- Enables the influx of proteins to the site of injury which are essential to rebuild and repair damage.
- Promotes the development of mature myofibers and collagen for sufficient tissue repair (otherwise repair can be insufficient leading to recurrent injury).
Anything that inhibits this process, including the application of ice (cryotherapy) and anti-inflammatories therefore, can be detrimental.
A new model has been proposed by the British Journey of Sports Medicine, that aligns with more current evidence:
After the initial injury occurs, it is important to protect the site of injury and prevent /restrict movement, so that the injury isn’t exacerbated. If there is pain at the site, we need to use this as a guide in the gradual introduction of movement and loading. We need to be mindful prolonged immobilisation can be harmful.
Elevation of the injury encourages blood flow in and out of the injury site easily.
A (Avoid anti-inflammatories and ice)
Research indicates that anti-inflammatory medications are detrimental for tissue healing and that enabling the natural healing process of inflammation encourages optimal healing. Higher doses are most detrimental. There is no high-quality evidence to suggest that ice is actually beneficial.
Compression may assist in the healing process and provide structure to an injured joint, preventing further damage.
It is important that now we have this information available, that we share it with other health care professionals and individuals- for best practice and enable better outcomes for clients.