Listen Now Download as mp3 from the show An Olympic Effort - Keeping Crowds Safe and Healthy
Colin Mackenzie asked:
I am intrigued by the constant use of ice packs for all manner of things including sports injuries, post surgical healing such as knee and hip replacements. However I have never been able to find any convincing scientific evidence that there is a rational basis for the use of ice.
What I know about the application of ice is that cold constricts blood vessels and that, post cold-application, the blood vessels enlarge to flood the area with blood. I fail to understand why the intermittent use of ice will reduce swelling or speed up healing.
We posed this question to Dr Jonathan Leeder, Physiologist at the English Institute of Sport.
Jonathan - Soft tissue injuries such a contusions, strains and sprains are frequent in multiple human endeavours and ice is commonly applied as part of the PRICE principle which stands for Protection, Rest, Ice, Compression, and Elevation. Ice is generally applied immediately post injury to reduce tissue metabolism thereby limiting secondary hypoxic damage and reduce the degree of oedema and muscle damage. Although this holds credited scientific rationale there is very little empirical evidence to support the use of ice at this stage.
Hannah - So, ice cools injured tissue down, lowers its metabolism and itís thought that this decreases the chance that the swollen tissue becomes starved of oxygen, and further damaged. Anything else?
Jonathan - The second common use of ice is in the rehabilitation stage Ė primarily due to the analgesic properties of ice application. The efficacy of ice application for analgesia, largely due to reductions in nerve conduction velocity is well-documented and supported by reasonable evidence base.
Although ice may be capable of reducing the painful symptom associated with soft tissue injury, there's limited evidence to suggest that the application of ice enhances the recovery rate of injury rehabilitation. It may just alleviate soreness during your recovery process.
Conversely, there's probably a growing evidence that suggested, it might actually be detrimental to attempt to reduce the inflammatory response through ice application because inflammation is a critical part of the repair process.
In summary, due to the proven analgesic properties of ice application, it does have a place in acute soft tissue management but due to lack of evidence in high quality research optimal protocols are not known.
Hannah - So, ice is known to be useful at stopping pain and it does this by lowering the speed that nerve cells send their electrical signal. Decreasing tissue temperature with the ice may also slow down the rate of production of inflammatory factors. And this will include some noxious pro-inflammatory metabolites that will sensitise nerve endings to pain. So cutting down the inflammation will cut down pain this way too. But the downside of this is that ice may also be slowing down your bodyís immune system and therefore, preventing your body from repairing itself.
vessels are ruptured , excess flow/swelling needs slowing CZARCAR, Mon, 25th Jun 2012
what effect would cold have on inflammatory chemicals, kinins, etc? Isnt that part of what causes pain beside swollen tissues pressing on nerves? cheryl j, Thu, 28th Jun 2012
It's a double edged sword. Ice could retard any bacterial growths that might occur that would further infect a cut say, but it would also slow down natural healing processes. Swelling like fevers are part of the natural design to aid in healing. james oliver, Sat, 30th Jun 2012
I have been wondering about this ever since I joined my high school cross country team and everyone used ice packs and baths (submerging the legs in a tub of 50 degree Fahrenheit water) after a run. I kept if it was really good for you and how it worked, and I never got a satisfying response. I thought that it would actually slow down the healing process by slowing the conversion of lactate back to pyruvate, thereby making you sore longer but because it was cold, you wouldn't feel it. When I asked my coach just said it reduces inflammation and that somehow helps the healing process (at the time I didn't know what happened during the inflammation process). So I thank you for explaining. Estelle, Thu, 20th Aug 2015
Isn't this uncertainty a very clear argument for a point of care randomised trial? Hugh Davies, Sun, 6th Dec 2015
The role of ice has been studied in a number of trials. See this 2012 paper as a starting point: www(dot)ncbi.nlm.nih.gov/pmc/articles/PMC3396304/ Stevebar, Wed, 23rd Dec 2015
In my Chef years ice or ice water was indispensable for treating burns, as far as other things for a swollen joint ice helps mrsmith2211, Sat, 9th Jan 2016