Do I Ice My Injury Or Not?


In the field of physiotherapy, best practice often changes based on findings of the latest industry research. One particularly controversial debate in physiotherapy is whether or not to apply ice to an injury after it occurs. It’s commonplace to instinctively apply an ice pack following a twisted ankle or other joint or ligament trauma. When watching sport, we often see professional athletes frequently being wrapped in an ice pack before they have left the field after sustaining an injury. Icing injuries by all appearances is a fundamental principle of acute injury management, however whether this practice aligns with the latest industry research remains to be seen.

The History of Ice in Physiotherapy

The use of ice in the treatment of acute injuries has been documented as early as 1978, when the RICE principle (rest, ice, compression, elevation) was first conceived. The ‘ice’ component of this treatment method was utilized as a mechanism of reducing inflammatory response in an attempt to accelerate the healing process. Since 1978, the RICE process has been adapted to include ‘P’ for protection (PRICE), and to swap ‘R’ for ‘OL’ – Optimal Loading (POLICE). This latter change was made following research which determined that rest is detrimental to a patient’s recovery and should instead be replaced by light mechanical loading to stimulate cell regeneration.

The ‘Ice’ component of acute injury management has remained consistent in physiotherapy practice for over 40 years. Today, anecdotal evidence demonstrates that ice makes injuries ‘feel better’ in the short term. This is supported by academic consensus that ice acts as a great analgesic, at least, on the surface of the skin. However, ice has no impact on underlying muscles which remain at a consistent temperature following the application of ice to the surface of an injury. This calls into question the medium-to-long-term effects of icing an injury.

Recent Adjustments to Perceptions of Ice Treatment

The efficacy of ice treatment for mild to acute injuries has actually come into question within the last decade. It’s known that after an injury occurs electrical signals are sent to our inflammatory cells which produce the hormone Insulin-like Growth Factor (IGF-1). These cells begin the work of healing by killing off damaged tissue. When ice is applied and the surface cells cool down, it’s possible that the natural release of IGF-1 is prevented (although, to what extend is unknown) and the initiation of the healing process may be delayed.

In 2019, the use of ice in physiotherapy treatment was officially revoked with the coining of the latest, most-comprehensive and longest acronym which represents acute injury management: PEACE & LOVE. This stands for Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularisation and Exercise).

Should I Ice My Injury?

Referring to the most-recent research in physiotherapy treatment, ice should probably be kept for Summer drinks rather than physiotherapy treatment. The only exception is in really severe injuries where swelling will likely limit overall recovery. In these cases, ice may be beneficial in the early stages only.

Have You Experienced Injury? Call Erko Physio Today

Erko Physio regularly treat a range of mild to severe injuries, and most patients respond favourably to physiotherapy treatment. Every case is unique, and we create tailored solutions for each client. 

Start your journey towards recovery with us, call now on 02 9557 9272 to make an appointment. We look forward to seeing you soon.