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Saturday, February 9, 2013

Is ice the best answer for acute injuries?

Is ice really necessary after acute injuries?

Throughout our lives we are taught certain “absolutes” that are rarely questioned and simply assumed to be “true”. In physical therapy school, I was taught the basics of human physiology in how the body responds to injury where the initial inflammatory reactions are to be addressed with the RICE principle of rest, ice, compression, and elevation. With almost two decades of clinical experience, I have to question the application of ice post acute injury. An inflammatory response brings increased blood flow to the injured site in order to facilitate the healing process. The increased blood flow creates heat and warmth to the soft tissues and the application of ice/cold counters this response. I find that the most benefit from this is the temporary numbing effect of any pain experienced. And if any of the initial swelling does go down, it is more so temporary where the injured limb swells up again later on. Does ice actually hinder the healing process and have we been blindly following the RICE principle without challenging it? We were taught to get the swelling down as soon as a possible and that’s why ice is issued. Prolonged swelling prolongs the inflammatory response and delays healing (so they say). But what if the application of ice is the culprit in prolonging the inflammation?

What’s been working for me?

I find what helps the swelling of acute injuries best is the following:

1)   Rest
2)   Compression – either with an ace wrap or sleeve or with kinesiology tape
3)   Pain-free movement of the involved body part as well as its neighbors
4)   Elevation
5)   Drinking more water with some sea salt
6)   And what I find to be the most effective approach to facilitate the healing process as well as reduce the acute swelling: dry needling with acupuncture needles……

Obviously, sticking yourself with acupuncture needles is not the most practical approach and requires professional assistance but the first five are very realistic. You can still use some ice, in my opinion, if you have a lot of pain. And if you do have a lot of pain , you still may want to get it checked out by your doctor to rule out more serious pathology such as fractures.




Above is is a picture of my sister-in-law who had sprained her ankle the day before this picture was taken. I treated her with electro-acupuncture followed by application of kinesiology tape. Where prior to treatment she had significant difficulty putting weight on her right leg making walking unpleasant, she was pain-free and walking normally the next day. And immediately after treatment she noticed how much easier it was to weight bear on the right and less pain.