Managing soft tissue strain and inflammation- To ice or not to ice?

We’ve all been there, you’re getting back into some exercise, you’ve pushed a little hard and strained a muscle. It hurts, it’s swollen and moving is an issue. You’re standing looking at a heat bag, strapping tape, a brace and an Ice pack. It’s decision time as you try and remember every bit of injury management wisdom you can, and finally decide ‘if football players still use it, it must be right’- and you opt for the ice pack.

Managing soft tissue strain with the use of ice has become a hot topic (I’m not even sorry for that one) in recent times. The method of injury management started in the 70’s when Dr Gabe Mirkin introduced the concept of RICE- Rest, Ice, Compression and Elevation when treating such injuries. The primary thought here being to limit inflammation, injury severity and time on side lines.

Whilst seemingly logical, it doesn’t quite stand up to testing and Dr Mirkin went on record in 2014 debunking the icing portion of the RICE acronym for soft tissue management.

The most popular argument against icing is that inflammation is an essential phase of the healing process and the application of ice to stop this process must therefore stop or at least delay healing.

While Dr Mirkin was amending his stance on icing in 2014, he also took the opportunity to explore his recommendation for complete rest following soft tissue injury. He went on to note that with ‘minor injuries, you can usually begin rehabilitation the next day’.

The exact details and science of this process continue to be keenly debated as science looks to once and for all settle the question. Proponents for icing suggest that it can desensitise the injured area making activity (primary reducer of swelling) possible. For the time being however, there is no evidence to suggest that suffering through long stints on the lounge with those frozen peas will actively reduce inflammation.

Dr Mirkin wasn’t completely off the mark though with his initial recommendations. Compression and elevation of acutely injured areas remains a highly effective practice and should be included in rehabilitation following low to moderate level injury.

As discussed, this continues to be a contentious topic for health professionals, coaches, trainers and weekend warriors alike, however for the time being, more evidence is required to take the ice out of your glass and onto your muscles. If the guy that wrote the book on injury management says don’t ice and move, maybe we should listen.