Lady Holding Ice Pack on Injured Knee

It’s obviously soothing. It’s the I in RICE, the generally accepted approach to relieving pain and swelling (rest, ice, compression, elevation). It’s so much a part of sports injury treatment that to suggest otherwise would be heresy. But then there’s the evidence, which makes things tricky. Because the evidence is that ice is not effective against muscle strains. Jim Newman investigates.

Sprain? Reach for the ice pack. Swelling? You’ll want to put ice on that too. In fact, ice has been the go-to balm of choice for as long as we’ve been injuring our joints. Ice is one of the key components in RICE, the default mnemonic used for treating sprains and swelling. And yet a decade of research suggests our relationship with ice needs to well, cool off a little.

“Ice is commonly used after acute muscle strains but there are no clinical studies of its effectiveness,” began the abstract to a 2012 study in the British Journal of Sports Medicine, before concluding, “Contrary to current practice, it is unlikely that a ‘panacea’ cooling dose or duration exists in the clinical setting.”

A 2013 study published in the Journal of Strength and Conditioning Research found that the use of ice could even be counter-productive, and that by inhibiting swelling the ice was delaying the body’s natural reaction to injury: “Topical cooling (icing) . . . seems not to improve but, rather, delay recovery from eccentric exercise-induced muscle damage.”


Patient preference

Of course, there’s one glaring issue with the data. Everyone knows that placing ice on an injury makes the patient feel better – irrespective of the reality of the situation. There is clearly an analgesic psychological effect going on. Or put more simply, ice just feels nice. And if patients like it, so do I, providing the ice isn’t getting in the way of the healing process.

So there’s a balance to be struck. Ice should never be applied to bare skin because you risk damaging the tissue. Even if you’re applying a bag of frozen peas to an injury, always wrap the bag in a tea towel or similar first.

Never ice for a prolonged period as it may reduce blood flow and hinder healing.

Always use ice in conjunction with the other elements of RICE (rest, compression and elevation). And to be strictly correct, RICE has now been replaced by POLICE, which replaces rest with protection and optimum loading. This reflects the fact that too much rest (like too much ice) isn’t beneficial. Instead, to stimulate healing in the injury, the joint should be mobilised – always slowly at first but increasing the range of motion over time.

There are occasions when ice may not be the right treatment choice – in patients with damaged or infected skin, for example, or where in areas of impaired sensation where the patient cannot feel the cold and cannot, therefore, say when it’s time to remove the ice pack. But in a general sense, whilst the scientific evidence in the clinical setting may be questionable, ice is likely to remain a go to way of pain relief.

If lockdown has left you with knee pain you can’t manage, contact us or phone us on 03453 052 579.

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James Newman

James Newman

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