To Ice Or Not To Ice Your Injury? An Updated Approach.

You may remember a blog we wrote commentating on the 2020 British Journal of Sports Medicine article for acute tissue injury care. This article suggested all we need to manage soft tissue injuries is PEACE and LOVE. Well science moves fast and there is a counter argument to this proposal already.

PEACE approach is described as

  • P Protection of the injury site
  • E Elevation
  • A Avoidance of anti-inflammatories and cryotherapy (ice)
  • C Compression
  • E Education

The PEACE approach may be an effective way to manage small injuries, however, Greek researchers argue that PEACE may not be the most effective for medium to large soft tissue injuries in the early stages.

The controversy is due to the use of ice – also known as cryotherapy. It is thought that ice is key in reducing or delaying inflammation, which some see as a bad thing. However, it may not affect the recovery time if you do or do not ice.

Furthermore, ice is thought to have many positive effects on large soft tissue injuries. In a larger injury the effect of swelling can include increased pressure on surrounding tissues including injured tissue and surrounding nerves. This can cause joint immobility and muscle inhibition resulting in reduced movement and therefore functional loss.

There is evidence that ice can limit the effect of the swelling, even if minimally, which helps reduce these effects. Ice has also been shown to reduce pain. Ice is also thought to reduce the secondary effects of swelling, like loss of oxygen to surrounding tissues, which implicates unharmed tissue.

The researchers therefore propose an alternative acronym for larger acute injuries – CARE

  • C Cryotherapy and Compression (ice and compression)
  • A Avoid harmful movements and loading
  • R Rehabilitation through specific techniques
  • E Elevation

If you have any issues with a soft tissue injury, large or small, come in and speak to one of our highly experiences Physiotherapists at one of our four Sydney city locations.


Fousekis. K., Tsepis. E. (2021) Journal of Sports Science and Medicine 20, 799-800

Minor Soft Tissue Injuries may need PEACE in the Acute Phase (

Campbell Hooker

About Campbell Hooker

Campbell Graduated from AUT University and has worked in private practice in both Australia and in London. Campbell has a keen interest in sporting injuries, office based injuries and the neck. He has worked at grassroots and elite levels of rugby union and league, and with surf lifesaving. He has recently taken to triathlon where he spends most of his spare time. Campbell has an interest in neurological conditions and has a Neuroanatomy degree out of Otago University. He utilises a number of methods when both analysing and treating patients, including dry needling and the Sarah Key Method.

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