One of the Coolest Questions Asked: “Should I be using ice?”

One of the most frequently asked questions by our patients being treated here at Symmetry Physical Therapy in Miami is “should I be applying ice to my injury?” It is indeed one that merits a detailed explanation, as the research on this modality has changed over the span of several years with new evidence based research.

The RICE Principle

In 1978, the RICE principle (Rest, Ice, Compression, and Elevation) was created by Dr. Gabe Mirkin with the intention to decrease swelling and to help accelerate tissue healing.1 When we injure a tissue (such as a strained hamstring), the immune system responds by rushing the area with blood and lymph containing T-Cells, Macrophages, and different growth factors to aid with tissue repair and removal of damaged tissue.2 This causes what we describe as “inflammation”, a healing process of tissues. The PRICE principle then evolved, essentially adding “P” for “Protection” which can include immobilization of the affected extremity.  When ice is applied to our bodies, it can cause a vasoconstrictive effect, reducing swelling, and also reduces localized pain in the short-term.2

BUT, as science leads us down the never-ending path of discovery, research has strayed away from these principles. Turns out that resting an injury is absolutely detrimental and can cause further insult to injury. This is when the POLICE principle rolled in (Protection, Optimal Loading, Ice, Compression, Elevation) since we learned that appropriate, graded, mechanical loads (through specific therapeutic interventions) optimizes tissue healing. Then we learned that cold application for injuries can actually DELAY healing by restricting the immune cells ability to do their job!3

Finally, after so many changes, 2 years ago the PEACE & LOVE (Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularization and Exercise) principle has been adopted and is currently the most utilized method for tissue healing. 4 See the chart below to familiarize yourself with it!

Should I be using ice symmetry pt miami

So We Should Never Use Ice, Right?

Wrong! Although it is preferable to avoid its use, there are times when it is necessary. Example would be for an injury that has resulted in severe swelling. In this case, surrounding muscles become inhibited and are limited in their ability to contract, hence will be further limited to stabilize joints for safety. Ice also assists with pain modulation. So you need to weigh the pros and cons before making a decision. 

What’s the Best Option?

To get physically moving, preferably under the guidance of a trained physical therapist! Click here to schedule an appointment to see us today!

Works Cited:

1.  Mirkin, G. & Hoffman, M. (1978). The sportsmedicine book. (1st ed.). Little Brown and Co.

2.  Mirkin, G. (2015, September 16). Why Ice Delays Recovery.

3.  Bleakley, C. M., Glasgow, P. & MacAuley, D. C. (2012). PRICE needs updating, should we call the POLICE? British Joint of Sports Medicine. 46, 220-221.

4.  Dubois, B. & Esculier, J-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54, 72-73.5.  Clough, J. (n.d.). Peace and Love: Soft Tissue Injury and Management. Image.