Sore neck? Put an ice pack on it.
Sprained ankle? Ice and rest.
Knee arthritis? You guessed it, slap an ice pack on that bad boy.
But new guidelines suggest it may be time to stop using ice.
The RICE protocol (rest, ice, compress, elevate) originated in 1978, when scientists realized that ice goes hard as a pain reliever.
But ice is now under fire, since researchers learned that ice may disrupt injury healing. And scientific support for this once-lauded treatment is melting.
In this article: Is it time to stop using ice? Why the case for cold therapy is on thin ice.
What Does Ice Do?
Icing an injury:
- Relieves pain
- Reduces soreness
- Controls swelling
All good so far. But ice also:
- Disrupts inflammatory cascades
- Reduces blood flow to the injury
- Delays the body’s normal tissue healing processes
Furthermore, cold-water immersion after exercise attenuates muscle hypertrophy, a massive downside for individuals training for muscle size and strength.
Ultra cold cryotherapy chambers promise the benefits of ice without the downsides. But there’s not much research yet.
3 Times to Stop Using Ice
Consider these 3 cases, where ice isn’t the optimal choice:
1. Moderate Ankle Sprain
Applying ice immediately after ankle injury arrests the body’s normal inflammatory response that shuttles blood flow and healing nutrients into the injured area.
This can delay healing and extend the recovery process.
In recent years, experts developed the PEACE & LOVE acronym instead of RICE, as I describe in this article.
2. Knee Osteoarthritis
Guidelines recommend against using ice for knee arthritis. Because it doesn’t improve pain, function, or quality of life.
And it actually increases pain for some folks with knee OA through a phenomenon called cold hyperalgesia.
3. Acute Low Back Pain
Back pain flare-ups almost always resolve on their own. And fast. The median recovery time is just 5 days.
Plus, about 90% of acute back pain subsides within 6 weeks.
Cold therapy is not recommended in back pain treatment guidelines. Instead, opt for an exercise-based treatment approach. And some guidelines favor heat over ice for pain relief.
And if you’re dealing with nerve pain, try The 7 Best Sciatica Exercises.
When Ice Works
In contrast, ice is right in these scenarios:
1. After Surgery
Always follow the surgeon’s guidelines… almost all of them include ice. Icing the surgical region keeps pain at bay, minimizes swelling, and prevents inflammation from raging out of control.
2. Pain Relief
Ice is a powerful pain-reliever for some folks, allowing them to sleep through the night. So if ice facilitates better rest (and therefore better healing), it’s worth it.
3. Soreness Reduction
Ice reduces delayed-onset muscle soreness (DOMS) after hard training and competition. Ice also blunts tissue adaptations, which is why smart athletes don’t use ice after training.
However, ice packs and ice baths can enhance performance in high intensity, multi-day sporting events.
Because entering Day 2 and Day 3 with less soreness can boost performance.
Further Reading
For a (really) deep dive into the therapeutic effects of cold therapy, including the history, cellular mechanisms and applications, check out this research article:
Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?
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