Ice is not always the answer!

For years ice has been the primary option for acute or sub-acute injuries with pain and swelling. In 1978, a sports medicine physician by the name of Dr. Gabe Mirkin introduced the principle of acute injury management known as “R.I.C.E” which is the acronym for Rest, Ice, Compression and Elevation. For years this has been the go to treatment method for acute and subacute soft tissue injuries.

However through years of studying and reviewing sports medicine research, Dr. Mirkin came to the conclusion that although ice can decrease pain, swelling and inflammation. Ice can also slow down recovery time to the acute or subacute injury. As a result Dr. Mirkin decided to reexamine the acute injury management principle he created and he found the following: Ice does not speed up recovery time. There is no evidence to suggest that ice and compression are more effective than compression alone. Also he found that the combination of ice and exercise may marginally help in the recovery.

As a result of the updated research on acute and subacute injuries, the British Journal of Sports Medicine published new treatment principles for exercise related soft tissue injuries in 2019. The new research removed ice as a treatment method which removed the acronym R.I.C.E from treating acute and subacute injuries. Instead the new acronyms are P.E.A.C.E for acute injuries and L.O.V.E. for subacute injuries.

P.E.A.C.E stands for protect, elevate, avoid, compress and educate. The P.E.A.C.E treatment method is most effective 1-3 days post injury and consist of the following:

·         Protect=reduce load and restrict movement for 1-3 days.

·         Elevate=elevate the injured area above heart level.

·         Avoid=avoid NSAIDS for mild to moderate inflammation.

·         Compress=apply pressure to inured area with elastic bandages.

·         Educate=encourage patients to take an active approach to managing their pain.

L.O.V.E stands for load, optimism, vascularization and exercise. The L.O.V.E treatment method is most effective during the subacute phase when there is no swelling, no redness or no burning in wound or injured area after the acute phase and consist of the following:

·         Load=gradually bear weight once the pain has subsided.

·         Optimism=Maintaining psychological stability can have a positive impact on healing.

·         Vascularization=Engage in appropriate aerobic exercise for better circulation.

·         Exercise=Rehabilitation can help with soft tissue healing and shorten recovery time.

A 2014 study published in the Knee Surgery, Sports Traumatology, Arthroscopy journal found that icing an injury can cause vasoconstriction and prevent the delivery of healing cells. The study also showed that blood vessels take hours to reopen after icing, which can lead to tissue death due to inadequate blood supply and even permanent nerve damage. While ice packs can alleviate the redness, swelling, and pain caused by sports injuries during the acute phase, there is controversy over whether they may delay the healing process. Therefore, taking a middle-of-the-road approach and using a warm compress is recommended.

The warm compress method is quite simple:

·         Soak a cloth in room temperature water.

·         Apply the wet cloth to the injured area.

·         Leave it on for 10 minutes, then remove it for five minutes.

·         Repeat the process twice.

Author: Eric Mack, D.C.