Should I Always Ice An Injury?

If you’re an athlete you’ve probably heard that you should ice an injury to reduce swelling and inflammation. For many years now the gold standard of care for sports injuries has been the RICE protocol – rest, ice, compression, and elevation. However recent evidence is now raising concerns about this conventional treatment. In fact, some of the criticism is coming from the doctor who coined the term in his Sportsmedicine Book (1978), Gabe Mirkin, MD, who recently released a statement retracting his earlier advice. (1)

It’s true that inflammation is generally not a good thing for your health. It’s implicated in a variety of conditions, including diabetes, heart disease, cancer, and even depression. But can inflammation sometimes be beneficial?

According to recent evidence, inflammation can support healing when it comes to acute injuries. (2) The swelling and discomfort we experience with an injury allows our bodies to increase white blood cells and other healing factors in the area, promoting faster recovery. (3) If we ice an injury and use anti-inflammatories, we slow down our body’s healing process by reducing blood flow, which brings nutrients and aids in tissue repair, and carries waste products away from the injury. (4)

You might have heard similar advice regarding fevers. Doctors are now advising that fevers are a normal part of the infection fighting process and that low grade fevers should be allowed to run their course. (5) Inflammation like fevers and swelling play a beneficial role in the body’s healing. In fact, studies now show that both ice and rest can actually delay healing. (6)

So if we aren’t supposed to be using the RICE protocol, what should we be doing instead? New treatment advice for athletes is known by another acronym: MEAT. (7)

MEAT stands for:

Movement– controlled movement within pain tolerance to stimulate blood flow and collagen production;

Exercise– correctly prescribed and performed exercises;

Analgesics– not anti-inflammatories, but other analgesics like arnica to reduce pain;

Treatment– working with a skilled osteopath or physiotherapist to implement appropriate treatments.

Is it ever appropriate to ice an injury? Since applying ice shortly after an injury can reduce pain, you can apply ice for a short period immediately following the injury (10 minutes on, 20 minutes off, repeat once or twice). Or alternate the ice with heat. There is no evidence for applying ice more than 6 hours after injuring yourself. (8)

Have you heard this advice before? Will you try MEAT the next time you are injured?