Prescribing Ice after an Injury
Is it time to COOL it?
Written by: Greg Macionsky ATC
Most people who have played organized sports or competed in something that requires some sort of movement at one time or another suffered an injury. Getting hurt is as much a part of the game as scoring a goal, making a basket, or catching a touchdown. Frontline healthcare providers, such as athletic trainers and physical therapists, have relied on ice as a means of controlling pain and swelling after injury. This goes back decades and is the most utilized modality to treat acute injuries; however, recent evidence suggests that not only have the positive effects of icing been overstated, but it may delay the healing process.
This isn’t to say that ice does not have any positive effects. Ice is a proven pain control modality, but this relief typically only lasts for 20-30 minutes post icing. Unfortunately, this short-term pain control can negatively impact the healing process. It does so by reducing inflammation. Wait what? Isn’t inflammation a bad thing? Hasn’t that been the message of every healthcare provider ever? This has been the prevailing thought not only within the medical community but among the public as well. However, recently this theory has come under fire from a number healthcare providers and researchers. The general idea behind that critique is that inflammation is not a bad thing. In fact, inflammation is vital to the healing process. The fluid that enters the injured site is responsible for carrying cells that begin the healing process. These cells are responsible for releasing hormones into the injured tissue. There is no disputing that ice slows the inflammatory process, so it is not a stretch to conclude that by keeping those important cells from reaching the injured tissue the healing process would be delayed.
If ice is not the answer, what should healthcare providers be prescribing? Exercise! The best thing one can do after suffering an acute injury is promote healing via appropriate rehabilitative exercise. This includes focusing on restoring range of motion, strength, proprioception, and balance. Early introduction of range of motion exercises is vital to decreasing stiffness to the injured area and restoring normal motion. Ice would do the exact opposite. When ice is applied the injured area becomes stiffer which can delay the process of regaining normal motion. Exercises that build strength are important for increasing stabilization of the injured area, and for preventing re-injury once the individual returns to sport participation. After suffering an injury proprioception, or the body’s ability to sense where it is in space, is compromised. The physical manifestation of decreased proprioception is the joint feeling unstable or a sensation of “giving out.” Combating injury is most effective when these areas are addressed.
While ice can help limit pain after an injury overutilization of this modality can have a slowing effect on the healing process. Most athletes want to get back onto the field as quick as possible. To achieve this, a rehabilitation program that focuses on range of motion, strength, balance and proprioception should be implemented as early as possible.