top of page

To Ice Or Heat?

Ice or heat? One of the most common questions I'm asked is whether to ice or heat an injury.


It can be confusing with so much conflicting information on the internet, combined with not knowing what sort of injury you have.


Most people are familiar with the RICE protocol, or the similar RICER method. Rest, ice, compress, elevate. It's been around for years. However, there's been contention whether this is truly the best management when it comes to acute injuries and recent evidence suggests aggressive icing isn't the best management. Then there's the No HARM, PRICE, POLICE, BE CALM, and PEACE & LOVE protocols. So which one should you listen to?





Old Thinking - Ice Or Heat?


It was thought that ice would help minimise blood flow and thus, swelling. Cold also acts as a natural pain reliever so it was recommended for years as best practice.


R.I.C.E.R

Rest: Take it easy in order to give the injury time to heal.

Ice: Ice the injury on and off in 20-minute intervals.

Compression: Bandaging the injury to prevent any further bleeding or swelling.

Elevation: Elevating the injury above your heart will aid in the reduction of swelling.

Referral: Referral to an appropriate medical professional for management.


No H.A.R.M Protocol

This method is used within the first 48–72 hours after the injury.

(No) Heat: Applying heat can cause blood flow and swelling to increase.

(No) Alcohol: Alcohol can inhibit your ability to feel if your injury is becoming more aggravated, as well as increase blood flow and swelling.

(No) Re-injury: Avoid any activities that could cause further damage.

(No) Massage: Massage can promote blood flow and swelling, and can cause more damage if done too early.


POLICE

Protection: This includes rest, avoiding aggravating movements, and/or periods of immobilisation.

Optimal Loading: Depending on which structure is injured (bone, tendon, muscle, ligament), complete rest may not be the best management and can lead to increased stiffness. This is best guided by a professional.

Ice

Compression

Elevation


New Thinking - Ice Or Heat?


It was Dr Gabe Mirkin who first coined the term RICE in his Sports Medicine Book in 1978.

However, he declared in 2014 that this protocol is outdated. There is a wide body of research showing that rest and icing is in fact harming rather than helping our healing.

When you damage tissue or develop muscle soreness by exercising very intensely, your immune system sends inflammatory cells to the damaged tissue to promote healing. Inflammatory cells rush to injury site to start the healing process (Journal of American Academy of Orthopaedic Surgeons, 1999). The inflammatory cells, called macrophages, release a hormone called Insulin-like Growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.


Applying ice to injured tissue also causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, 2014). The blood vessels do not open again for many hours after the ice is applied.


Instead, a couple of new protocols have been proposed that fit well with the research. I particularly like the BE CALM protocol for dancers as it takes your mental state into account as well as the physical injury.


There are 2 versions of BE CALM. One is for soft tissue injuries, the other for bone injuries.


BE CALM for Soft Tissue Injuries

Breathe: take a few breaths to calm your nervous system.

Evaluate: Is this a bone/head/spinal cord injury? If so, the management if different. Can you move your limb? Is there a sharp pain? Are you able to weight bear? If unsure, seek professional help. If you suspect a fracture, see BE CALM for bone injuries.

Compression: Use a bandage or tubigrip to compress the injured area ensuring it's not too tight.

Able Actions: Gently move your injured body part to determine which movement(s) you can do in a pain-free manner. These are your “able actions.” Don’t worry if the pain-free range is very small for the first few days, this will improve as it heals.

Lift/Elevate: When able, elevate the injured area above your heart.

Minimal Ice: 5 minutes maximum for ice ON, 20 minutes ice OFF, up to 4 cycles


BE CALM for Bone Injuries

Breathe: take a few breaths to calm your nervous system.

Evaluate: can you move your limb? Is there a sharp pain? Are you able to weight bear? If you think you have a fracture, seek professional help.

Crutches/Cast

Arrange an X-ray

Lift/Elevate

Minimal Ice: 5 minutes maximum for ice ON, 20 minutes ice OFF, up to 4 cycles


You can find the full protocol here.


The other research backed protocol is the PEACE & LOVE protocol.


PEACE & LOVE

Peace & Love Protocol for injuries

Hopefully that sheds some light on the ice debate. Comment below any questions.


Happy Dancing!




References

Buckwalter JA, Grodzinsky AJ. Loading of healing bone, fibrous tissue, and muscle: implications for orthopaedic practice. J Am Acad Orthop Surg. 1999 Sep-Oct;7(5):291-9. doi: 10.5435/00124635-199909000-00002. PMID: 10504356.


Dubois B, Esculier J, Soft-tissue injuries simply need PEACE and LOVE, British Journal of Sports Medicine 2020;54:72-73.


Khoshnevis S, Craik NK, Diller KR. Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2475-83. doi: 10.1007/s00167-014-2911-y. Epub 2014 Feb 23. PMID: 24562697; PMCID: PMC4395553.





1 comment

Recent Posts

See All

1 Comment


This is really informative and helped me understand how the body heals. I'm not a dancer but stumbled across this while looking for how to treat an injury and it was a big help. Thanks Grace!!

Like
bottom of page