Injuries: ice, heat, neither, or both?

R.I.C.E or P.R.I.C.E or P.O.L.I.C.E

Most people would have heard of the terms R.I.C.E, P.R.I.C.E or P.O.L.I.C.E before, it may have been from a first aid course or even on a poster around your local sport’s clubrooms. The theory is for an injury that just occurred we need to follow the acronym R.I.C.E. which stand for;

R - Rest from activity

I - Ice (apply cold therapy to the injured are)

C - Compression (compress the area with bandage or compression stocking to restrict swelling)

E - Elevation (Raise the injured area to above the level of the heart to prevent increased swelling and blood flow to the injured area)

Other variations to this such as P.R.I.C.E. add the P which stands for protecting the area (whether it be crutches or splinting). And P.O.L.I.C.E adds in the need to Optimally Load the injury with an appropriate exercise, instead of just resting from activity all together.

The effects of applying ice

Using cryotherapy or cold therapy is thought to restrict and slow down unwanted swelling to an inured joint or muscle tissue. Applying a cold pack or bag of frozen peas can also alleviate your pain by providing an almost numbing effect to dull the pain intensity. This sounds all beneficial right? So why could using ice “be doing more damage than good” as a recent news article has suggested?

Whenever you injure yourself, you body will do everything it possibly can in order to help the natural healing process occur. This includes swelling around the injured area - increased fluid and blood can help the recovery process by providing vital nutrients to an injury and help clean up the debris, so we MAY be slowing down this process by applying ice to an injured area.

Should my heat pack replace my ice bag?


Not exactly, if we were to apply heat to an injury this may cause excessive bleeding that may have occurred - this is why heavy deep tissue massage is not appropriate for an injury that has just occurred. Heat therapy is great at helping “tight” muscles and “stiff” joints relax only after there is no more swelling occurring, think of how relaxed you feel after a warm bath or shower.

Is the best treatment no treatment?

This is highly dependent on the severity of the injury and the damage occurred. If you have stubbed your toe, you might have some bruising appear, but this would rarely require you to put ice on your foot. However, if you have rolled over onto your ankle, although the swelling is providing some benefits, excess swelling may even restrict you from moving your foot at all. The body can overshoot the amount it needs to swell in some cases, and in order to restore movement back, swelling needs to decrease first.

More recently the acronym P.E.A.C.E & L.O.V.E has been suggested as an alternative to R.I.C.E


What should I do?

If you have recently suffered an injury follow these general guidelines relating to hot/cold therapy;

  1. If Ice is going to help decrease your pain then only apply Ice to an injured area for no longer than 15-20 minutes, every couple of hours only for the first 48 hours after an injury (this is when most of the excess swelling may occur) - do not do this directly onto your skin (use a towel or Tubigrip stocking as a barrier) as this can cause a cold burn.

  2. Apply a compression bandage or Tubigrip to restrict the amount of swelling.

  3. When and if pain allows, try to regain normal movements as soon as possible, in the case of a lower limb injury, try to put weight down and walk normally as soon as you are able to - this prevents the muscles from “switching off” by keeping them active.

  4. Heat packs may help only once there is no residual or continued swelling and bleeding occurring - usually week after the injury occurred

  5. Consult your local health professional for any exercises or strategies that may help the healing process.