a and reduce swelling following soft-tissue injuries (Wang and Ni, 2021). However, recent research questions the efficacy of prolonged icing, suggesting it may delay healing and extend recovery times (Wang and Ni, 2021). This raises an important question: does the ingrained practice of icing injuries align with the latest scientific insights?
Chilling Traditions: The Evolution of Injury Management Acronyms
Over the years, acronyms guiding the management of soft-tissue injuries have evolved from ICE to RICE, PRICE, and POLICE (Dubois and Esculier, 2020). Initially, ICE (Ice, Compression, Elevation) emerged as a general guideline before 1978, despite being coined without robust scientific backing (Wang and Ni, 2021). The practice gained traction in sporting circles after Dr Gabe Mirkin popularised RICE (Rest, Ice, Compression, Elevation) in his 1978 book The Sports Medicine Book (Mirkin and Hoffman, 1978).
For decades, RICE became the standard approach to treating sprains, strains, and other soft-tissue injuries. However, in a striking reversal, Dr Mirkin has since denounced the icing methods he once championed, citing concerns about its impact on the immune response and muscle healing (Aschwanden, 2019).
Cooling the Flames: Inflammation’s Role in Healing
Inflammation is a crucial component of the body’s natural healing process. It promotes tissue repair by facilitating the infiltration of neutrophils and macrophages, angiogenesis, and revascularisation. By slowing blood flow, icing may hinder these critical processes, delaying recovery and potentially impairing tissue repair (Dubois and Esculier, 2020). Despite this, the analgesic effects of ice remain beneficial for short-term pain relief (Wang and Ni, 2021).
PEACE & LOVE: A Modern Approach
In 2019, the acronym PEACE & LOVE was introduced, representing a significant departure from earlier guidelines. This comprehensive framework emphasises protection, elevation, avoiding anti-inflammatory drugs, compression, and education, followed by load management, optimism, vascularisation, and exercise (Dubois and Esculier, 2020). Notably, it omits ice, reflecting a growing consensus that cryotherapy may disrupt the healing process (Wang and Ni, 2021).
Ice or Not? A Nuanced Approach to Ice therapy
While evidence suggests that icing may impair healing, its use cannot be universally dismissed. For severe injuries with significant swelling, ice may help limit oedema, reducing pressure on tissues and nerves and improving functionality (Fousekis and Tsepis, 2021). In these cases, ice therapy can be part of a tailored approach, such as the CARE model (Cryotherapy and compression, Avoid harmful movement, Rehabilitation techniques, Elevation), which addresses the unique needs of moderate to severe injuries (Fousekis and Tsepis, 2021).
Conversely, for minor injuries or during training phases aimed at maximising long-term adaptation, ice may act as a barrier to recovery. In such scenarios, focusing on inflammation and repair processes is essential (Wang and Ni, 2021; Aschwanden, 2019)
Conclusion
The role of ice therapy in injury management and recovery is increasingly viewed through a nuanced lens. While ice offers temporary pain relief and may reduce swelling in severe cases, its broader impact on healing calls for careful consideration. Modern approaches like PEACE & LOVE emphasise a holistic view of recovery, steering away from traditional reliance on ice. As the science continues to evolve, clinicians must adapt their practices, balancing immediate relief with long-term recovery goals.
References:
Aschwanden, C., 2019. Good to go: what the athlete in all of us can learn from the strange science of recovery. First edition ed. New York: W.W. Norton & Company.
Dubois, B. and Esculier, J.-F., 2020. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), pp.72–73. https://doi.org/10.1136/bjsports-2019-101253.
Fousekis, K. and Tsepis, E., 2021. Minor Soft Tissue Injuries may need PEACE in the Acute Phase, but Moderate and Severe Injuries Require CARE. Journal of Sports Science & Medicine, 20(4), pp.799–800. https://doi.org/10.52082/jssm.2021.799.
Mirkin, G. and Hoffman, M., 1978. The sports medicine book. Boston: Little, Brown.
Wang, Z.-R. and Ni, G.-X., 2021. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World Journal of Clinical Cases, 9(17), pp.4116–4122. https://doi.org/10.12998/wjcc.v9.i17.4116.
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