To Ice or Not to Ice…That is the Question

If you’ve ever sprained your ankle during weekend netball or AFL, you might have heard of the acronym “RICE’. Rest, Ice, Compression, Elevation. You may have even heard of POLICE. Protection, Optimal Load, Ice, Compression and Elevation.

But have you ever heard of PEACE & LOVE?

P  ROTECTION

E  LEVATION

A  VOID ANTI-INFLAMMATORIES

C  OMPRESSION

E  DUCATION

&

L  OAD

O  PTIMISM

V  ASCULARISATION

E  XERCISE

PEACE & LOVE is now being welcomed as the preferred management strategy to manage acute to subacute injuries. Dr Gabe Mirkin, who coined the abbreviation ‘RICE’ back in 1978 has come out in 2014 to retract this advice. This comes with new and emerging research surrounding the possible influence ice may have on delayed healing.

The British Journal of Sports Medicine published an article in 2019 outlining the PEACE & LOVE management pathway which has been summarised below.

Acute Management: PEACE

Protection:

To minimise further aggravation of the injury site, the advice is to ‘unload and restrict’ movement for approximately 1-3 days. However, prolonged rest can compromise the tissue strength. Pain should act as your guide.

Elevation:

Elevate the injured area above the level of your heart to encourage fluid to flow out of the affected area.

Avoid Anti-Inflammatories:

Inflammation is a natural process of healing, therefore, inhibiting inflammation may negatively affect the long term healing of tissues.

Compression:

Using an elastic bandage or taping, compress the area to reduce excess swelling to and tissue haemorrhage.

Education:

Education surrounding the benefits of an active approach to recovery.

 

Subacute Management: LOVE

Load:

Mechanotransduction is the process of which muscles, ligaments and tendons will begin to repair and remodel when placed under optimal loading. Pain is an important guide when determining whether to increase or decrease load.

Optimism:

Maintaining optimistic expectations will help prevent negative psychological barriers from impeding on recovery. Optimism has been linked with better outcomes and prognosis.

Vascularisation:

Early return to pain free cardiovascular activities increases motivation and improves return to work or sport rates. Aerobic activities increases the blood flow to the affected tissues to encourage healing.

Exercise:

Exercise is important for regaining mobility, strength and proprioception. Pain should act as a guide when progressing exercises to ensure optimal repair during the subacute phase.

It is however, important to note that in some instances, ice may aid in reducing excessive swelling.

Further research still needs to be conducted to investigate the extent of the risks vs the benefits of using ice or cryotherapy to manage acute injuries so make sure you watch this space…

References:

Singh, D. P., Lonbani, Z. B., Woodruff, M. A., Parker, T. J., Steck, R., Peake, J. M. (2017). Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. [Frontiers in Physiology] Publised online March 7 2017; 8: 93.

Dubois, B., Esculier J. F. (2019). Soft Tissue Injuries Simply Need PEACE & LOVE. [British Journal of Sports Medicine] Volume 52, Issue 2.

Sarah Silva

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