ICE - does it actually help with tissue healing?
For a long time, ice has been one of the mainstays of acute injury management. The magic remedy to any ailment. It’s only been in recent years that people have begun to think, ‘does it actually help with tissue healing?’
The earliest documented use of ice in acute injury management was when the acronym RICE (Rest Ice Compression Elevation) was coined by Dr Gabe Mirkin back in 1978. Since then, it’s been the mainstay for most soft tissue injuries. Anecdotally, people often swear by it, praising the ice for helping them through the painful stage of the injury. This is supported by research as well, with ice being shown to have an analgaesic (pain relieving) effect. However, this seems to be where the effect of ice stops. More recently, it’s been shown that ice doesn’t affect the temperature of underlying musculature, with some going as far as suggesting that it slows the healing process down. This throws ice’s tissue healing capabilities into question.
The rest component of ‘RICE,’ has also been a hot topic in the last ten years. Emerging research has begun to show that complete rest and ice may hinder the healing process. The reason behind this is that the initial stages of inflammation may play a crucial role in initial cell healing. Ice may limit that effect. A preference for ‘optimal loading’ has emerged out of this, as we know that carefully exposing tissue to load can help maintain movement and strength and help to accelerate through the recovery phase. Some have gone as far as telling people to avoid ice altogether. Some still believe it has a role to play in injuries where a large amount of swelling or pain is present such as in ACL injuries and post knee replacement.
From this breadth of research, a new acronym has emerged which aims to hit all the crucial points of acute injury management through to early rehabilitation. ‘PEACE & LOVE’ (Protect, Elevate, Avoid anti-inflammatories, Compression, Education & Load, Optimism, Vascularisation, and Exercise). This was developed by the British Journal of Sports Medicine and provides a strong outline of the steps we as physiotherapists take to manage your injury and get you back to where you need to be.