The Cold Truth About Icing Injuries

Ask any athlete what you should do if you sprain a joint or tear a muscle and they will respond with RICE (Rest, Ice, Compress, and Elevate). While icing may reduce pain, there is little evidence of its effectiveness in enhancing recovery. For example, research from the Emergency Medicine Journal concluded that there is “insufficient evidence to suggest that cryotherapy improves clinical outcomes in the management of soft tissue injuries.” In addition, researchers Hubbard and Denegar concluded “Despite the general acceptance of cryotherapy as an effective intervention, evidence on which to base these conclusions is limited.”

Icing can actually lead to the potential for increased injury since it decreases nerve conduction diminishing motor function (i.e. agility). In addition, icing numbs the injured tissue allowing athletes to push through unnoticed pain when they begin to exert themselves after icing. The article Why Ice May be Bad for Sore Muscles by Gretchen Reynolds discusses these points in greater detail.

One of the biggest potential negative impacts of icing was found in research released from the FASEB Journal suggesting that “muscle inflammation after acute muscle injury is essential to muscle repair by means of insulin-like growth factor-1 (IGF-1). The study found that the presence of inflammatory cells or macrophages in acute muscle injury create elevated levels of IGF-1 which significantly increases the rate of muscle regeneration (see press release).” To summarize, the body naturally responds to injured tissue by releasing cells that restore damaged muscles, tendons, and ligaments. Icing causes local vasoconstriction, or decreased blood flow, which could negatively impact the effects of inflammatory cells slowing the process of muscle regeneration and ultimately the speed of recovery.

This topic of discussion lacks conclusive evidence thus making it challenging to provide clinical suggestions for the appropriate use of ice.  Based on the severity and type of injury, icing may still be appropriate for controlling excessive swelling. Ultimately, every injury is different and needs to be assessed and monitored to determine the severity of swelling and the rate of recovery. Based on the fact that there is little evidence that icing improve recovery outcomes, and new research suggesting that icing may inhibit recovery, you may want to think twice about icing an injury with only limited or moderate swelling.