Many athletic trainers, therapists and strength coaches in North America are now avoiding the use of ice for post injury/performance recovery. After listening to some of the biggest names in the athletic rehabilitation arena speak on this topic, I have shifted my way of thinking to a more unorthodox approach. This does not mean that I am going against scientific research, I am actually following the research more closely.

We were always taught to Rest, Ice, Compress and Elevate for dealing with acute injuries that present with swelling or edema of some sort. The acronym being R.I.C.E. I still believe that there is merit to this formula, but a gentle tweak may give this acronym more value.

From my understanding of basic physiology, icing can have a negative effect on the healing process. Please see blog 3 (stages of healing). The initial response to injury is the inflammatory cascade which occurs to ensure that specific chemicals required for healing enters the injured and surrounding tissues. Along with these chemicals comes prostaglandins and substance P which are pain stimulators. These will help to protect the area from further damage telling you to back off. When we apply cryotherapy (ice) the blood vessels constrict preventing blood flow to the area. This is why icing can decrease pain. Just because ice takes the edge off, it does not mean that it won’t slow down the healing process by preventing the other good stuff from getting there.

Furthermore, studies show that ice does not help with swelling that is already there. An area will swell because the blood entering the tissues carrying the “groceries” leaves byproducts from the metabolic processes of healing. These byproducts can be flushed out by the lymphatic system as it is activated by the squeezing of the muscles surrounding the lymph. But… when we are injured we are told to rest and due to the pain, we often do not activate our muscles, thus the lymphatic system becomes dormant and congested causing more pain.

Im sure this is leaving you confused as to what should be done to avoid excessive swelling. I prescribe a slightly different method to avoid/get rid of swelling.

  1. Elevation: Elevating the limb above the level of the heart will put gravity on your side, assisting venous return and lymphatic drainage.
  2. Compression: Compressing the tissue will help to prevent stretching of the surrounding soft tissues and assist in dispersing the edema.
  3. Muscle activation: This is KEY! Activation of the muscles will help to activate the lymphatic system. Think of the lymph as a chain of bags with one way valves. The muscles that surround the lymph will contract to squeeze these bags pushing the fluid upward, while the one way valves prevents backflow. When the muscles relax, a sucking mechanism helps to pull more fluid into the bags. This fluid eventually gets flushed out of the body.

In summary ice will constrict the blood vessels preventing blood from entering the injured area, thus swelling will be minimized at the cost of hindering the healing process. Ice should only be applied for temporary pain relief and no longer than 5 minutes at a time.

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