To Ice or not to Ice?
Recent newspaper articles discussed whether using ice for acute ankle sprains was actually useful for recovery. The article suggested that all we thought about using RICE (“Rest, Ice, Compression, Elevation”) was wrong, or at least not really helpful. The devil, though, is in the detail….
In fact, the paper described by the journalist is a meta-analysis, where the authors assess all the papers they can find on the issue and make a summary document. The risk with meta-analyses is the detail gets lost in the summary, and this is what has happened here. While the overall conclusion was that the evidence is not strong, there are several studies (here, here and here) that show that effective icing does improve functional outcomes (e.g. getting back to sport faster). Effective compression and elevation is also beneficial (here, and here).
Note my emphasis in the word “effective”: as ever, if you’re going to do something you need to do it properly!
RICE has been the mainstay of the sports trainer’s kit for decades. The theory goes that if you can minimise the swelling after an ankle sprain then it will stiffen up less, and recover faster. The opposite argument goes like this: if you rest, elevate and cool the ankle, you will decrease blood flow to the injured area, decrease the supply of inflammatory cells to the area and limit the ability of these cells to start the healing process. Sounds plausible, but it hasn’t been studied at all yet. Maybe we’re not wrong after all?