The Myth About Icing an Injury

What if one of the most common pieces of advice to heal an injury wasn’t actually effective? It's something we've been told since we're kids - apply ice to an injury. But what if I told you that icing an injury to reduce inflammation, once thought to speed up the healing process by reducing inflammation was simply not true? 

For years the procedure for acute soft tissue injuries was the RICE protocol (rest, ice, compression and elevate). This protocol had been used by doctors, trainers, and physical therapists for years but Dr. Gave Mirkin, the man behind this procedure and protocol, now disagrees. "My RICE guidelines have been used for decades, but new research shows rest and ice actually delay healing and recovery" (Berra 2019). Increasingly, current research from several systematic reviews and randomized control trials indicate that while icing can provide pain relief it doesn’t reduce inflammation or improve the healing process. Ice became a popular anti-inflammatory because it was the cheapest, non-habit forming way to alleviate pain. But once you remove ice the pain will return as the tissue re-warms and the inflammatory process resumes.

The Inflammatory Process

To understand why ice isn’t effective at expediting healing, we need to understand the inflammatory process. We all have an inflammatory process (dogs too!) – it is a normal, natural, and necessary physiological response to injury or tissue damage. Inflammation starts the healing process and cleans out the damaging stimuli. Swelling and inflammation is considered a necessary evil – it increases your sensitivity to pain which in turn limits your ongoing activity to prevent additional injury. 
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Basic physiology and tissue healing includes three main phases:

1. Inflammation - a localized reaction to injury or infection from the body. The injury site may become red, swollen, sore, and warm to the touch.
2. Proliferation - the wound is 'rebuilt' with new granulation tissue by macrophages and white blood cells. 
3. Remodelling - the tissue around the injury is overhauled to enhance tensile strength. Cellular activity declines with time and the number of blood vessels in the affected area decrease and recede. 
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​If we alter the inflammation phase (by applying ice),  we cannot reach the second and third phases. When an injury occurs the body sends out macrophages, and white blood cells - the repair and cleanup crew of the immune system, to the site of the injury. This cleanup crew produces protein insulin-like growth factor-1 (IGF-1) which is needed for muscle repair and regeneration. When we apply ice to this process we constrict blood vessels, allowing less fluid to the area of injury and delaying/hindering the cellular repair and cleanup crew. This narrowing of blood vessels also persists once we remove ice from the injury - meaning that even after icing we continuing delaying the inflammation process and interrupting the natural healing function of the body. Additionally, the restriction of blood flow from constricted blood vessels can also kill otherwise healthy tissue causing more damage to the existing injury and surrounding area.  

Alternatives to Ice

Inflammation is a desirable process the body uses to heal itself. However, with inflammation comes the by-product of swelling. Too much swelling can be a bad thing so learning how to clear swelling from the area of an injury is a way you can help you dog in the healing process. Some of the particles found in inflammation fluid are too large to move through the vessels of the circulatory system and instead must move through the lymphatic system. The lymphatic system is comprised of lymph nodes and lymph vessels which drain fluid from the body's tissues. The lymphatic system, however, is a passive system reliant on muscle activation - so movement is necessary to propel fluid through these vessels. By sitting and icing an injury we work against the body's natural processes for dealing with an injury! 

So what else can we use to help reduce pain and swelling? 

• Heat! Low levels of heat to the muscles around the injury (not directly on the injury) can help relax neighbouring tense muscles and increase circulation.  By managing the tissue around an injury we can minimize compensation issues. 
• Laser: Cold laser stimulates healing via low levels of lights. Body tissues will absorb this light and it will cause a reaction in the cells with a physiological reaction that promotes regeneration. Laser increases cell growth and metabolic activity in the cells. While cold laser does decrease inflammation its primary function is SO much more and works with the body's natural process to speed up healing, not against it.
• Compression: Part of the original RICE protocol, compression can help by adding pressure that creates a pumping effect at the injury site. This pumping effect mimics the body's natural muscle movements and helps reduce swelling, fluid build up, and increases arterial blood flow. Remember, you don't want the compression to be too tight as this can cut off circulation. Monitor the area around the compression bandage - if you see swelling below the affected area you may have applied the bandage too tightly. 
• Keep moving! Movement is medicine and by activating the lymphatic system we can reduce swelling around the area of injury!  Isometric exercises (a form of exercise involving the static contraction of a muscle without any visible movement in the angle of the joint) is a great way to introduce controlled movement  and promote circulation that also avoids aggravating the tissue of the injury. 
• Seek out the help of a health care provider to discuss acute pain management strategies. 

​So what does this mean for you? You can use ice on your dog for temporary pain relief, but recognize that it won't affect swelling, function, or range of motion. The best strategy to reduce swelling is simply to wait it out- and let it do exactly what it was designed to do

References

Berra, Lindsay. "The Cold Hard Truth About Icing Your Injuries." Mens Health(Nov 2019). 

Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251 261.

Bleakely, C., et al. Cryotherapy for acute ankle sprains: a randomized controlled study of two different icing protocols. Br J Sports Med. 2006; August 40(8):700-5; discussion 705.
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Dubois, Blaise and Jean-Francois Esculier. "Soft tissue injuries need PEACE & LOVE," Br J Sports Med. (2019)

Jam, B. Questioning the use of ICE given inflammation is a perfectly healthy response following acute musculoskeletal injuries. (May 2014). Advanced Physical Therapy Education Institute