Should you ice an injury?

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I’ve never quite understood the rationale, or obession we seem to have, behind icing an injury. From what I hear the theory is reduce inflammation and swelling, which will then help the injury heal faster. However, if the body is generating all this inflammation and swelling immediately after an injury, maybe it is a necessity? Maybe it’s to the body’s benefit?

I have a hard time believing evolution is so inefficient that after a typical ankle sprain the body has evolved to generate a response so undesirable we need to manufacture the complete opposite response.

In fact, in a lot of injuries, such as tendon or ligament injuries, many rehab programs are designed to increase blood flow to the injured site. Yet somehow we are also constantly bombarding the injured site with ice to “decrease inflammation and swelling?”

If you look into cryotherapy enough in the research world you will find a couple of traits:

1) There are a lot of really crappy studies done, which all say previous studies are really crappy.

2) Ice is consistently found to decrease pain after an injury.

In reference to 1): A lot of studies done on ice/cryotherapy are not well controlled. For instance, one study looking into ice had a control group but the experimental group that experienced benefits used ice and compression. So you can’t derive which one gave the benefit. Furthermore, you can’t have a placebo group when it comes to conducting an ice study. (If you’re using / not using ice, you know it.)

In reference to 2): Giving people Vicodin also decreases their pain…that doesn’t mean it improves their return to activity or helps their injury heal. And in terms of helping the injury heal there isn’t much, if any, evidence justifying the use of ice. Again, the studies aren’t the greatest, but with what we have they don’t say much in favor of ice.

First, from

–Feasibility and effectiveness of ice therapy in patients with an acute tear of the gastrocnemius (calf) muscle:

“For functional capacity, reconvalescence time, work absenteeism and pain relief, no significant differences between the intervention and control group were found. “

Second, from

–Does Cryotherapy Improve Outcomes With Soft Tissue Injury?

“Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth.”

Third, from an “executive” (whatever that means) review of the PRICE (Protect Rest Ice Compress Elevate) treatment for acute injuries:

“There is moderate clinical evidence that cold therapy is effective at decreasing short term pain after acute ankle injury and general soft tissue contusion{…}There is moderate clinical evidence that ice has little effect on other clinical outcomes including recovery time, function, and swelling (limb girth).”

Link:

–Management of acute soft tissue injury using Protection Rest Ice Compression and Elevation: Recommendations from the Association of Chartered Physiotherapists in Sports and Exercise Medicine

Lastly, from a paragraph on ice in Kendall’s Muscles: Testing and Function, with Posture and Pain:

“There are a number of conditions for which therapeutic cold should not be used. Cold should not be applied to muscles when the following conditions are present: hypertension (due to secondary vasoconstriction) […], vascular impairment (e.g., frostbite or arterioscleroris) […].”

This is something I have never heard before. I’ve asked a couple of people who are involved in physical therapy or medicine and they’ve never heard of it either.

It makes a lot of sense though. In those with hypertension the blood vessels are constricted due to excessive plaque buildup and such. Therefore, there is less room for blood to flow through the vessels, which causes the heart to have to work harder to pump the same amount of blood through, causing high blood pressure. The idea behind icing an injury is to constrict blood vessels to help rid the area of blood / swelling / inflammation.

This is definitely not an area I know much about but I am assuming the idea behind not wanting to ice an injury in a hypertensive person is you don’t want to be much which will constrict the already constricted blood vessels even more. Doing so could potentially further increase the risk of a heart attack or stroke. In fact, at least one study I found shows whole body cryotherapy increases blood pressure. Granted this isn’t the same as localized icing, I think it’s still worth mentioning.

I also think this is significant considering nearly a third of the country has high blood pressure. Lord knows how many are also experiencing pain at any given moment.  Pain they are likely using ice to treat.

Conclusion: Icing doesn’t seem to improve outcomes after an injury. It doesn’t seem to have any negative impact either. I’d say go based on you respond to ice. Personally, and from many who I’ve talked to, icing just makes the injured site feel stiff as all hell and is a pain in the ass. I know others that love it though, and feel like they get quite a bit of pain relief out of it.

Unless you have high blood pressure it doesn’t make much difference either way.