Imagine you’re walking along past the local shops, about to cross the street when you footing on the gutter and roll your ankle. You are able to stand on it but it is a bit painful and walking is only possible with a mild limp. A passerby saw this happen and rushed over to see if you are okay. They run off to grab some ice for your ankle.
Reaching for the ice to aid soft tissue injuries has been instinctual for most people since learning the acronym RICE over the last couple of decades. RICE was first used by a prominent Doctor of Sports Medicine, Gabe Mirkin, back in 1978 (1). The premise was that rest from any aggravating activity with ice and compression in an elevated position will help reduce pain, manage swelling (inflammation) and optimise recovery. Fast forward to today, and there are many health professionals who suggest that maybe our rationale for this was a bit off the mark and that ice isn’t as important a reflex when you hurt yourself.
Physiotherapy is an industry that is constantly reflecting on what the best current evidence recommends us to do. This is often thought out in conjunction with patient ideals/preference and clinical expertise in mind. Dr Mirkin himself has reflected upon his early advice regarding ice with acute soft tissue (skin, muscle, ligament, tendon) injuries and even suggests that ice can potentially delay recovery. Dr Mirkin cites research from the early to mid 2010’s that shows ice can delay the arrival of crucial healing substances to injured tissues. In fact, there are over 30 studies that noted reduction in strength, speed, endurance and coordination from the use of ice for a period of 20 minutes or longer. This was reversible, however, through a short period of re-warming (2).
As physiotherapists, it is common place to use ice for pain relief only and even then it is used for short periods of time. Dr Mirkin’s current advice can be seen on his website and he still recommends compression but states “It is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.” It is important for our team to stay up to date with the latest research so that we can relearn certain practices for the good of our patients and their injuries.
For further reading please feel free to check out the references below, including a 2019 piece from the Sydney Morning Herald that provides some more detail on this topic. (3)
If you have a soft tissue injury or would like to chat to a Physiotherapist about current best practice for treating these injuries, please contact us to book an appointment with one our experienced Physiotherapists for treatment.