Icy Dilemma: Should You Use Ice for an Injury or Pain?

You’ve likely heard about the RICE method to help injuries or soreness — Rest, Ice, Compression, and Elevation. When you experience back pain or a sore knee, you may apply ice to help you recover and speed up healing. However, ice may not be the best solution for your unique situation. So, should you use ice or not? In short, the answer is… it depends.

To determine if icing is right for you and your injury, consider the following question: What are the goals of any actions taken after injury?

The big goal is to maximize blood flow to assist healing. Vasodilation, or expansion of blood vessels, increases blood flow and delivers oxygen, nutrition, hydration, and tissue repair product to the site of injury. Inflammation is part of that process. All of your treatment choices should be based on this.

1. Ice for acute injuries, such as an ankle sprain.
   Yes, but only apply ice 10 minutes at a time. Ice will numb the pain if severe, but applying ice for long durations can cause rebound swelling. Elevation and compression are key components to control swelling after immediate injury. There will likely be significant early joint swelling. This is the body’s mechanism of placing a cast around an injury, which is normal. However, uncontrolled, massive swelling will hinder those blood vessels from expanding, in turn, reducing fluid exchange and slowing the healing process.
2. Ice for Delayed Onset of Muscle Soreness after exercise.
   No, ice application will not help with Delayed Onset of Muscle Soreness (DOMS) after exercise. DOMS is the accumulation of metabolic waste product in muscles and tendons after moderate to heavy use. Think “I need to flush this system clean” to clear the waste sitting there. In this situation, elevation is the best choice to let gravity do the work for you. You will see endurance athletes, runners, soccer players, cyclists, etc. lie on the floor with feet up on a wall to assist with flushing the system clean; just 15 minutes will do the trick. This is my go-to when my legs feel dead and sludgy after a long run or cycling session. Next, get moving with a slow and easy warm up the next day. Walking, easy cycling, or swimming will increase the heart rate and improve blood flow to assist with flushing the system clean.
3. Ice for muscle spasms.
   Yes, ice will work as an anti-spasmodic. Application of ice for 10 minutes will calm a muscle spasm and allow you to start moving. Numbness is not pain and the movement it allows will help the healing. Controlled pain allows movement, which expands blood vessels to increase oxygen, hydration, and nutrition to promote healing. For example, ice application on the neck at the base of the skull will stop a suboccipital headache almost every time.
4. Ice for pain relief.
   If you have a long history of overuse injuries due to training or competition and tournament or international rules prohibit the use of pharmaceuticals, then ice application to control pain and swelling to get you through the competition is acceptable. Do not forget about elevation and compression. After the tournament or competition, maximize blood flow to assist with healing. For example, if you are experiencing horrific pain and cannot move to increase blood flow, heat application is like throwing gasoline on a fire and the pain will likely get worse. In this case, ice application for several bouts of 10 minutes will move your pain meter in the correct direction. Then, beginning to move will lead to vasodilation and promote healing.

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