When should I use ice?

The use of ice has been a widely debated topic in the world of physiotherapy in recent years, especially for acute injury management. Placing an ice pack or a bag of frozen peas on a sprained ankle or knee is what the majority of us will do immediately after an injury. But is this the correct way to manage an acute injury or even a long term niggle or ache? We took a look at the latest evidence, as well as our own clinical experiences to address this question.

For many people after an acute injury, placing ice on the injured area makes them feel better. This is because ice is a great analgesic, meaning it causes pain relief. Ice cools down the skin temperature significantly and likely turns down the volume on the danger signals in the newly injured area.

So, ice makes an injury feel better in the short term but what effect does this have on your injury in the mid to long term? Ice may reduce or impede the inflammatory process. Surely this is a good thing? No. Inflammation is the body’s natural healing response. When there is disruption to our tissues (ligaments, muscle etc), our body sends blood and swelling which carries white blood cells and oxygen to this area. This is a desirable process. So, applying ice to an acute injury appears to delay the healing response and therefore increases your recovery time. This is why Ice was revoked in 2019 from the injury management process.

If you have recently used ice on an acute injury, don’t panic! You have not caused any more damage, just potentially delayed the process slightly.

For someone who doesn’t have an acute or new injury, where there is no obvious inflammatory process, is it okay to ice? We say yes. If ice or cold makes you feel better then this is something we would encourage.

If you decide to ice, make sure to wrap your ice or bag of frozen peas in a pillowcase or a towel before applying to the skin. Sudden exposure to cold temperatures can damage skin. Use caution on areas with reduced sensation if you have neuropathy (from diabetes or another condition) or Raynaud’s syndrome.