Recently there has been some debate about the RICE (Rest, Ice, Compression, Elevation) theory for the treatment of acute injuries. In one article, Josh Stone postulates that ice is overused, suggesting that it may inhibit healing because it reduces inflammation. Inflammation is a natural and necessary part of the healing process.
Let’s visit the four phases of healing.
Bleeding occurs following injury or trauma to an area. How long bleeding lasts and how much blood escapes into the tissue depends on how well vascularized the injured tissue is. Generally, the time between tissue injury and the end of bleeding is between four and six hours. However, this may vary for different tissues.
Inflammation is an essential phase of healing. The onset of inflammation occurs roughly a few hours (2-3) post injury and reaches its maximum over the next 1 – 3 days, lasting for a couple of weeks. The events that initiate inflammation include mechanical irritation, repeated minor trauma, excessive heating and cooling.
Involves the delivery of healing cells, most commonly referred to as scar tissue (collagen). This process usually occurs 1 -2 days after injury, reaches its peak after 2 -3 weeks and then decreases over a period of several months. The end result of this phase is the deposition of the scar tissue material. It is through the remodeling that follows proliferation that a high quality scar tissue is formed.
Remodeling is said to begin when the proliferation stage reaches it peak (2-3 weeks post injury). It results in the formation of a scar that is not necessarily the same as the original tissue but is organised, behaves in a similar manner and allows the patient to return to normal function.
You can read more about tissue healing in this interesting article.
Taking in to consideration the order of the healing phases listed above, Stone’s article argues that ice reduces blood flow and therefore prevents or delays the healing cells from entering the injured tissue. As an alternate, Stone suggests that ice should be used as a pain reliever and applied for up to 10 minutes with a 20-minute break and then re applied for 10 minutes once or twice in total.
You can read Josh Stone’s article about how best to use ice in the article on his website:
Dr Natasha Paunovic is an experienced Osteopath at Melbourne Osteopathy Sports Injury Centre. She assists with positive long term outcomes by providing patients with education, lifestyle advice and rehabilitation exercises.