Sports Injury Pain management: To Ice or Not?

This is a hot topic in the world of sports injury management. Research tends to dictate the way we treat injuries and thus the instructions on what we should be doing changes fairly regularly. The use of ice on injuries is a good example.

Instinctively we use ice on a new injury. We see it on television and the we know that the ice will ‘take away’ some fo the pain, at least in the short term. And the injury causes heat and swelling (inflammation) and heat is not good (or so we have been lead to believe).

The guidelines over the years have evolved from

RICE (rest, ice, compression, elevation)

to

PRICE: adding the concept of Protection.

Then in 2012 there was a shift to

POLICE: Protect, Optimal Loading, Ice, Compression Elevation

Research indicated that Optimal Loading helped with recovery through cell regeneration which is induced by light mechanical loading. Resting, it was established, was bad for recovery.

Ice itself is a great painkiller. It does this by cooling the skin and distracting the brain through its ability to prioritise some sensations over others. But research has established that the superficial ice does nothing to the underlying tissues, like muscle; the temperature within them stays the same.

Ice does in fact delay healing by affecting the necessary benefits of the inflammatory process, in particular inhibiting the release of a hormone called Insulin-like Growth Factor (IGF-1). IGF-1 kills off damaged tissue. Ice may actually be inhibiting the release of this hormone delaying the healing process.

There was then another shift when ice was finally removed from the protocol completely and PEACE & LOVE was introduced: (Protection, Elevation, Avoid anti-inflame, Compression, Education and Load, Optimism, Vascularisation and Exercise).

There may be one caveat and that is in the prevention of excessive swelling. So when that ankle rolls and goes up like a balloon some ice may be warranted. However when the hamstring tears with less swelling, then ice is less likely to be of any benefit during the management of the injury.