To Ice or Not to Ice? New Research challenges PRICE protocols
May 28, 2014
One of the most frequent questions that clients ask me when they get hurt is "Should I use ice on my injury?". As it turns out the medical literature is still not sold on the value of icing / cryotherapy on an injury. Multiple studies have consistenly failed to demonstarte any significant value in frequent icing of an acute sprain or strain (2,3,4,5,6). The goal and application of cryotherapy has always been to limit blood supply to the region and thus, limit the amount of pro-inflammtory products, thereby, decreasing pain, swelling, and reducing recovery time (2,3,4). Although, in case reports a positive relationship is demonstrated that cryotherapy does indeed decrease pain and swelling, it has not been shown to decreased recovery time and in fact systematic reviews and ramdomized clinically controlled studies have demonstrated that icing leads to increased injury recurrence (5,6). Moreover, the data suggest thats there is not a statistically significant difference between icing and not icing. Rather new studies have focused on weight bearing and eccentric loading rehabilitation.
To date multiple studies have demonstrated that eccentric loading of the injury (muscle or joint) shows to decrease recovery time more significantly then icing (2,5,6). In conjuction with eccentric loading exercises weight bearing exercises and patterning exercisis have been shown to be effective (2,3,4).
So the question is should we not ICE? Should we forget PRICE and RICE?
Well, even with the current evidence I firmly believe icing to reduce pain and swelling in the first 24-48 hours shows a beneficial therapeutic effect as it limits the acute inflammatory response. This in conjuction with eccentric loading, weight bearing, and range of motion exercises will aide recovery and help prevent future injury.
Proper rehabilitation and return to exercise and play is paramount and should be supervised by a healthcare professional. Afterall, the best way to prevent future injury is to ensure that your rehabilitation is completed properly and that the underlying patterens that may have lead to your injury have been correct.
For more on the topic please see and read the sources below. I have include links to some of the journals (many are subscription free).
3) Bleakley et al (2006). Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med 2006;40:700-705 (http://bjsm.bmj.com/content/40/8/700.short)
4) Bleakley et al (2007). The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain. BMC Musculoskelet Disord. 2007 Dec. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2228299/)
5) Hubard et al (2004). Does Cryotherapy Improve Outcomes With Soft Tissue Injury? J Athl Train. 2004 Jul-Sep; 39(3): 278–279. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/)
6) Bleakley et al (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004 Jan-Feb;32(1):251-61. (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0021236/)