To ice, or not to ice?

We’ve all twisted an ankle and instinctively grabbed some ice to make it feel better. We never questioned whether it was working; it was just common sense that icing it was the best thing to do. Is it possible that all these years we’ve had it wrong? Lately, there has been a lot of coverage in the media surrounding the use of ice post-injury and whether or not it actually works. Some researchers, trainers, professional athletes and therapists are supporting the idea that you should toss out your ice packs and eat those frozen peas because they won’t help your injury and may actually be making it worse. What has lead to this new way of thinking and is it supported by research?

The Healing Process

Let’s start with the basics. Once a tissue is injured the body will respond by increasing blood flow to the area and sending specific cells to start the repair process. Unfortunately, this leads to inflammation, redness, pain and increased temperature at the injury site. For years, ice has been used during this stage of healing to limit swelling and reduce pain. The two fundamental effects of icing an acute injury are 1. vasoconstriction of blood vessels, which will decrease the blood flow to the area; hence limiting the amount of swelling, and 2. Ice will block and reduce pain by decreasing nerve impulses. We know physiologically what ice does, but practically, does the research evidence support these findings?

What does the research say?

Unfortunately, there is not a lot of high quality research surrounding this topic, which makes it hard to come to any conclusions. Maclean’s magazine recently published an article on why icing doesn’t help injuries. However, they only cited two research articles to support their claim along with anecdotal evidence. A study by Tseng et al., (2013) continually gets cited to support the “ice is bad” claim. The study was conducted on only 11 healthy subjects, which found icing delayed recovery from eccentric exercise-induced muscle damage. This isn’t a huge sample size to hang your hat on such a claim. They also cited Bleakley et al., (2004), who conducted a review of the literature and found insufficient evidence on the benefits of icing post-injury. More recently, Collins (2008) review of the literature showed that there was sufficient research to support that modest icing helped reduce swelling, but excessive and prolonged icing was damaging to the injured tissue. Furthermore, Hubbard et al., (2004) conducted a review of the literature and showed that icing soon after injury was effective in speeding up return to play. They hypothesized that the quicker return to play was due to better pain control.

Take home message

Ice is beneficial during the early phases of healing in order to control excessive inflammation and help with pain control. However, long term, it has been shown that prolonged use of ice can interfere with blood flow and the delivery of cells and oxygen needed to stimulate tissue formation and healing. Should you toss out your ice packs? Probably not. Ice is still beneficial for acute swelling and pain control, and at the very least, for keeping your beverage cold long-term!!

Bleakley et al., (2004). The use of ice in the treatment of acute soft tissue injury. A systematic review. The American Journal of Sports medicine. 251-261.

Collins, N.C. (2008).Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emergency medicine Journal. 65-68.

Hubbard et al., (2004). Does cryotherapy hasten return to participation? A systematic review. Journal of Athletic Training. 39(1): 88-94.

Tseng et al., (2013). Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. Journal of strength and conditioning research. 1354-1361.