Questioning the Use of Ice for Injury Management

By Karenlee Thompson

Back in college, a visiting professor described an injury and the application of ice as a first response.

‘Who agrees?’ he asked.

There was a flurry of hands in the air. The professor then asked if anyone disagreed. Nervous and beetroot-cheeked, I lifted my hand. In that room with around forty students, there were more than a few chuckles and I definitely heard the word ‘idiot’.

The learned professor asked me to explain why I disagreed. I was nervous and unsure of myself but managed to splutter something about recent research. Although I was unable to provide citations there in the classroom, I said I felt that there was enough research to warrant a challenge to the status quo. Much to my relief and surprise, the prof agreed. I went from pariah to popular in the space of a few minutes.

Player Wellbeing or Victory at all Costs

My interest in this topic stems from my love of watching Australian Rules Football. It seems the job of the medical team and support staff is to return an injured player to the field as quickly as possible and, looking at the litany of long-term injuries of high profile players, I silently began to question the accepted protocols.

I wasn’t initially questioning the methods, but rather the end result: What was the first priority – the health and wellbeing of the player, or the scoreboard? I’m not about to question an individual practitioner’s response to injury but my interest in the topic led me to various articles and opinion pieces on the efficacy or otherwise of ice as a legitimate response to injury.

What Do the Experts Say?

On Physical Therapy Web, Dr Bahram Jam, physical therapist,  specifically reviews the possible negative effect that icing can have on tissue remodelling and concludes that the temporary pain reduction arising from the application of ice is not worth the hindrance to proper maturation and collagen formation. (Tip: Read Part 2 of this article as well for the use of NSAIDS – link at the bottom of the article.)

Physical Therapist Justin Vanderleest, writing for The Globe and Mail  highlights the importance the inflammatory response plays in infection control.

Anatomy and Physiology study taught me that the human body is an amazing universe; one that heals, invents and adapts. I picture the body’s inflammatory response as a little internal ambulance with its lights flashing and sirens blaring, carrying leukocytes and macrophages to the site of the injury to get the clean-up started. So why is icing still popular despite the research?

Pain Be Gone, Please

I think about the footballer who has fallen awkwardly on their ankle. The fall causes pain and restriction of movement. Having experienced the way ice will numb an area and remove some of the impediment to movement, I can understand that the footballer, pleased with the decreased sensitivity afforded by the ice pack, is keen to get back on the field to kick another goal. Even as I cheer my team on, I think about how this overriding of pain and removal of restriction might lead to weakness and degeneration down the track, due to the body being unable to do its job of healing itself.

As a Remedial Massage Therapist with a number of sports clients, I sometimes find myself in discussion about the efficacy of ice and I always encourage people to research the topic and come to their own conclusions.

There is a modern aversion to any sort of pain. As someone with a low pain threshold, I can appreciate this desire to avoid pain. However, if I’m told that the pain is unlikely to get any worse than it is now, that it is my body’s way of protecting itself from further injury, and that the pain will lessen within a reasonable amount of time, then I’d rather cop a bit of pain than cause irreparable damage.

Question. Research. Debate. Analyse.

Thinking back to that class with the visiting professor, and kicking my own goal, we should remember to put some trust in our own observations, to be unafraid of stepping to the outskirts – or, indeed, to the front – of the herd. Remember to always question, research, debate, analyse.

Want to learn more about the icing arguments?

Help yourself to a selection of articles and studies and comment below if you have other resources to share:

Paul Ingraham at Painscience on the pros/cons and the state of the evidence (April 2017)

Does Cryotherapy Improve Outcomes With Soft Tissue Injury? by Hubbard and Denegar (2004)

Cryotherapy Reduces Inflammatory Response Without Altering Muscle Regeneration Process and Extracellular Matrix Remodeling of Rat Muscle by Gracielle Ramos et al ( January 2016)

About the author

Karenlee Thompson is a writer of fiction and non-fiction with a BA in English Literature and Journalism. Her memoir – “Memoir Mine” – has been shortlisted for the Lane Cove Literary Awards 2017. Following an extended bout of injury and ill health, she found herself in the capable hands of a remedial massage therapist and was astounded by the improvements to her health and wellbeing. Upon recovery, she enrolled to gain her RMT qualifications and now works from her home clinic on the Redcliffe Peninsula in Queensland. She has two chooks and a veggie garden and she dances (alone) like Seinfeld’s Elaine. Follow Karenlee on Facebook

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  1. Im a myotherapist and now studying Chinese Medicine. A lot of concepts between the two compliment each other but until now the use of ice had been opposed. In CM cold is seen as a pathogen and causer of disease, inhibiting healing or indeed causing further dysfunction in the long run. Glad to see this article giving a western approach to why this is so.

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