R.I.C.E. Rest, Ice, Compression, Elevation has long been the go-to treatment for acute injuries such as sprains, strains, and contusions (Bruises). Some recent studies have shown that using ice on an injury may not work or can even delay the healing process. So, should you use ice to treat an acute injury? That depends on how you use it and when you use it. Applying ice for a long period of time immediately after an injury can actually delay the healing process. The following post is my two cents about using ice to treat injuries.

The theory behind using ice on injuries is to reduce swelling and numb/decrease the pain. This sounds like a good thing doesn’t it? In theory, yes, but some recent studies have shown that the body needs swelling and pain to trigger the body’s natural response to heal the injured area. (Tell that to the person who just severely sprained their ankle, or blew out a knee writhing in agony.) From my experience and experimentation of various techniques in the trenches  I have found the following technique to work the best for treating acute injuries. This technique can be used up to 72 hours post-injury.

I first learned the R.I.C.E. technique explained below from one of my favorite professors of all time Doug Davis at Bergen Community College 24 years ago.

To perform this technique, you will alternate periods of icing with periods of non-icing using compression and elevation. Many people simply leave ice on for an extended period. This I have found can impede the healing process and I personally do not advise that method. Instead, perform the following.

1. Get an ACE Bandage and saturate it under cold running water. Be sure to let it get saturated. It takes a bit of time. You want to use cold water and make sure that it is wet to maximally conduct the cold through the bandage while also protecting the skin. Ice directly on the skin can cause ice burn which is not pleasant or beneficial.
2. Using half the ACE bandage snuggly (not too tightly) wrap the bandage around the injured area. Be sure that it is just barely overlapping each time you wrap the bandage around the area, so it is not too thick. You want it snug to help slightly compress the area to control the swelling and give the injured area support.
3. Take the ice pack (real ice works better than the cold gel packs but you can use whatever you have) and lay it on the injured area. Use the remainder of the Ace Bandage to hold the Ice pack in place. These Ice Packs are great and can also be used for heat packs. They also come with a convenient elastic strap to hold the Ice Pack in pace. If an area is too large for one ace bandage to both cover the skin and holds the ice pack in place use two bandages.
4. If possible, elevate the injured area to decrease blood pooling in the area and to encourage proper venous and lymphatic drainage.
5. Keep the ice on smaller areas (ankle, wrist) for 15 minutes and large deeper injured areas (thigh, hips, back) for 20 minutes.
6. After 20-minutes remove the ice and bandage and let the area naturally warm back up to body temperature for 30 minutes for smaller body parts and 40 minutes for larger body parts. Try to keep the injured body part elevated at this time as well. This will once again help decrease blood pooling in the area and encourage proper drainage.
7. Try to repeat this sequence a minimum of 3 times in a row if possible and as many times as you can for up to 72 hours after the injury. At which time it may be advisable to switch to contrast treatment using cold and heat. (coming in another blog post)

The theory of how this works is 4-fold.

1. Compression (from the bandage) helps control swelling and gives the injured area support.
2. Elevation uses gravity to naturally help the injured are reduce swelling by decreasing blood pooling into the injured area and allowing venous and lymphatic return.
3. ICE (temperature) causes vasoconstriction which decreases internal capillary leakage (bleeding) and swelling. Ice also numbs the area to reduce pain and spasms.
4. Letting the injured body part warm back up to body temperature encourages increased blood flow to the injured area to warm the cold tissue which in turn brings in nutrients and important immune cells such as, macrophages that help clear away damaged cells due to injury, initiating the repair process that triggers inflammation, also producing insulin-like growth factor-one, enhancing muscle tissue reconstruction

To summarize, using Ice therapy in this way with compression and elevation triggers the body’s own mechanical responses causing a pumping effect from vasoconstriction and dilation to help “pump” out inflammatory chemicals and damaged tissue and to also “pump” in nutrients, important immune and healing cells to start the repair of the injured area.

In conclusion, if you do get injured it is important to first consult the proper health care practitioner to evaluate and diagnose the injury and recommend treatment. The information mentioned above is not to take the place of proper care by a physician. However, if you do decide to incorporate the use of Ice therapy then the method mentioned above has been highly effective from my experience.

If you give it a try please let me know how it works for you.

To your health,

Kevin