The Great Debate: Should You Ice After an Injury?

You’re sprinting down the basketball court and go up for the game-winning layup. As you land, your ankle gives way and you hear a loud pop as you fall on your backside. Immediately, your ankle starts to swell and you have to be helped off the court. Luckily, one of your teammates has a medical background and they yell for someone to go grab a bag of ice. Does this scenario sound familiar? For decades, the protocol for treating a sports injury has followed the acronym R.I.C.E – Rest, Ice, Compression, and Elevation. However, since the acronym was coined in the late 70s by Dr. Gabe Mirkin, he has since changed his stance on the issue. 

In his original argument, Dr. Mirkin discussed that icing the injured area was an important aspect of the recovery process because it reduces the pain by producing a numbing effect as well as decreases the swelling and inflammation of the injured area. However, recent studies have shown that cooling does delay the swelling, but it doesn’t necessarily hasten the recovery from muscle damage. 

In fact, for damaged tissue or sore muscles to heal, the body actually uses its immunity to heal, which are the same biological mechanisms that are used to kill germs. This is called inflammation. When germs invade your body, your immunity sends cells and proteins to help kill the germs. Similarly, when muscles or tissues are damaged, the body’s immunity sends the inflammatory cells to the damaged area to help promote healing. However, applying ice to the injured area to reduce swelling actually works against the body because it prevents the healing hormone Insulin-like Growth Factor (IGF-1) from being released. 

After further investigation, Dr. Mirkin realized that applying ice to the damaged area also prevents healing cells from entering the injured muscle or tissue. When ice is applied, the blood vessels near the injury start to constrict and shut off the blood flow that brings in the healing cells of inflammation. These blood vessels do not open up again until several hours after the ice was applied. This decreased blood flow can actually cause the tissue to die and potentially cause permanent nerve damage to the injured area.

Finally, Dr. Mirkin argued that using ice on an injured area actually reduces strength, speed, endurance, and coordination. Approximately 35 medical studies were done on the effects of cooling. Most of these studies used cooling for more than twenty minutes, and most reported that immediately after cooling, there was a decrease in athletes’ strength, speed, power, and agility-based running. For athletes who may attempt to return to the field of play shortly after icing their injury, it is important that they take time to warm the injured area back up. Otherwise, they may be putting themselves at further risk for injury because their bodies are not fully prepared to engage in these types of movements. 

Although Dr. Mirkin has reversed his stance on applying ice to an injured area, many physicians, athletic trainers, etc. still continue to use R.I.C.E. as a method for treating injuries.