You’ve likely heard the same advice as almost everyone else when it comes to soft tissue injuries: rest, ice, compression and elevate? It’s almost standard and universal practice in first aid for sprained ankles, muscle pulls and other such injuries. But what if icing isn’t helping? What if icing is slowing down your full recovery and affecting the quality of the healing?  As a physiotherapist, I treat people with these injuries regularly and in some cases, ice can be more harmful than good when trying to get athletes back to sports in the best shape possible. Why? I’ll explain below, so put down the ice pack and read on!

Why Do We Use Ice In the First Place?

Firstly, why do we even use ice in the first place? In short, ice reduces the inflammation that occurs after you sprain your ankle or pull a muscle. Overstretching a muscle or tissue beyond its normal range and load capacity when you go in for a heavy tackle, or desperately reaching out to hit that difficult badminton shot has the potential to cause structural damage to a tissue. In other words, pushing a muscle, tendon or ligament past its usual limits can hurt it! Much the same as if you keep adding more and more weight to the end of a rope, eventually it will snap when the weight is too much for it to bear. This is called tissue damage or trauma.

Tissue damage causes the release of a number chemicals at the cellular level called inflammatory mediators which signal to the body that there is damage and that it needs to be fixed. These inflammatory mediators lead to a rush of blood to the damaged tissue and trigger nerves to send pain signals to your brain which encourages you to stop using the tissue. The swelling you see on the side of your ankle, the heat you feel when you touch that pulled hamstring, and pain you feel when you try to walk are all a direct result of the inflammatory process we just described.

How Does Ice Work?

Ice works by cooling the area around the injury which in turn constricts the blood vessels flowing in and out of the area. This process reduces the amount of fluid that collects in the tissue and decreases the number of inflammatory mediators present around the injury site. As pain from soft tissue injury’s is mostly from inflammation and extra pressure on the joint from all of that fluid built up, ice also reduces pain felt after an injury.

So far so good? Not quite. As nice as that cooling ice feels on a hot and swollen twisted ankle, why are we messing around with nature’s tried and tested healing method? The answer is pain relief, and only pain relief. Which in itself is a good thing, but you must consider the trade off in future performance and speed of return to sports or preferred activity.

A now famous study published in the Journal of applied physiology studied the effects of icing damaged muscle tissue immediately after an injury and found that, in the medium and long term, it decreased the tensile strength of the muscle, making re-injury more likely! It turns out that the early swelling of an injury is vital to recovery as it brings all the chemical signals and tools that will start the repair job. Putting ice on a mildly swollen muscle or ligament is like taking your car to the garage to fix your brakes, then tying the mechanics hands behind there back!

So Ice or No Ice?

Let me be clear here, I don’t hate ice, I’m not ice phobic! I often use ice with my patients who have soft tissue injuries and other conditions. That said, there is a difference between the mildly swollen ankle of a 55-year-old who goes jogging twice a week and the gluteal tendon of a 19 year old competitive triathlete. One may choose to enjoy the pain relief and go back to jogging in a few weeks, the other may select a different treatment approach with the aim of reducing long term injury risk.

At PhysioActive, we don’t just put ice on everyone who presents with an acute soft tissue injury. We sit down and discuss your goals, activity levels and expectations, then we formulate an individualised management plan that is best for you and your goals.

Ice Is just the tip of the iceberg (pun intended). There are many different treatment techniques with which to treat different conditions, some will be more suitable for you than others depending on a wide variety of factors. That’s what makes PhysioActive unique – we focus on, and treat the individual, not just the injury!

Reference: Takagi, R, et al. Influence of Icing on Muscle Regeneration After Crush Injury to Skeletal Muscles in Rats. J of App Phys. February 1, 2011 vol. 110 no. 2 382-388

This post has been written by Physiotherapist Kieron Phillips.


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