When an injury involves the soft tissues of the body (muscles, ligaments, tendons, fascia) there is a definitive three step process that takes place following the initial injury. When this process is allowed to run its course, which varies on the severity of the injury (4 weeks to 12 months) those tissues have the ability to heal and return to their original functionality. The process contains these three steps:
- Step 1 – Acute Inflammation
- Step 2 – Tissue Proliferation
- Step 3 – Tissue Remodeling
Step 1 – Acute inflammation
Acute inflammation is a process that is intended to last no longer than 48-72 hours. During acute inflammation blood flow is increased to the sight of injury, the blood vessels around the site of injury become more permeable (easier for substances to move in and out of the vessel), and neutrophils migrate to the injured area. The action of increased blood flow, increased permeability and neutrophil action accounts for the hallmark signs and symptoms of inflammation. Those hallmarks are as follows:
Step 2 – Tissue Proliferation
Following acute inflammation (~48-72 hours later) tissue proliferation takes place. Cells show up to the area of injury and begin to lay down of new tissue to replace the original damaged structures at a disorganized and high rate.
Step 3 – Tissue Remodeling
Because step 2 took place at such a disorganized and high rate, the new tissue that was laid down doesn’t possess all the functional characteristics that it should (strength, pliability, elasticity, etc). Additional cells arrive and begin to organize the new tissue that had been laid down.
The application of ice to the human body does a few things. As stated before, ice will decrease the amount of pain you experience. Ice also acts as a vasoconstrictor. In other words, it constricts the blood vessels where applied. This constriction acts to decrease the blood flow to that area, in turn decreasing the amount of inflammatory response (anti-inflammatory effect).
As outlined before, following tissue damage a specific 3-step process ensues. Since ice acts as an anti-inflammatory, its application has the ability to delay or inhibit the completion of acute inflammation. In other words, the application of ice can elongate the acute inflammatory response beyond its normal 48-72 hours or halt its completion which would inhibit tissue proliferation from taking place.
But I’ve Always Iced in the Past…
The application of ice comes from the age-old sport medicine mnemonic, RICE. RICE is short for the application of:
The RICE protocol is designed to act a first-line defense for controlling an over-reactive inflammatory response following severe injuries. An over-active inflammatory response is detrimental to tissue healing and can even cause tissue death. An over-active inflammatory response looks like severe swelling and intense pain (think an ankle the size of a softball and pain so bad I feel like crying!)
- Ice is great for pain – but that’s about it
- All soft tissues heal by going through the same process – ice potentially slow this process
- When tissues don’t go through the three step process they are more prone to re-injury
If you’re serious about rehab your injury and returning to 100% as quickly as possible, icing is not the answer.