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Treating Injuries with P.R.I.C.E.
Does it really work?

Should you ice an injury?

Ankle sprains account for 85% of all sprains. They're the most common sports-related injury involving ligaments. The treatment that coaches and athletes have been taught to administer can be broken down into a simple phrase. "Protection, Rest, Ice, Compression and Elevation." P.R.I.C.E.

You're supposed to PROTECT the injured body part from further harm. REST, stop or take a break from the activity that caused the pain or injury. ICE the affected area for 10 to 20 minutes at a time, three or more times a day. Apply COMPRESSION to the injury by wrapping it with some sort of elastic bandage. Then ELEVATE the sore area above the level of your heart, to minimize swelling.

Each step is designed to prevent further injury and maximize healing. But here's where it gets a little strange. Even though there are thousands of these injuries a year, remarkably few studies have ever been conducted to see if it's actually beneficial. Logically every step seems to make sense, but does the research backup our beliefs?

Let's start with PROTECT. You might put on a brace, use a splint or wrap the injured area to prevent additional injuries. It can even mean simply stopping the activity that caused the pain or damage in the first place. There's no controversy with this step, you don't want to continue an activity that caused harm. Doing so would only risk greater damage.

REST has also been proven to be highly effective. It gives your body time to repair the damage without inflicting new stresses. However, that doesn't mean you should be completely immobile. Therapeutic exercises can ensure increased blood flow (to speed healing) and prevent joint stiffness. Muscles that aren't worked regularly can lose as much as 3-5% of their strength in just a few short days.

ICING an injury may not provide the long-term benefits people originally believed. The immediate effect of icing is to reduce pain and swelling. But that doesn't mean you heal faster.

In 2013, Tseng CY published a surprising study in the Journal of Strength and Conditioning Research. Test subjects were either given a topical cooling or a sham (fake) treatment. Then, tests were run on everything from muscle hemoglobin concentrations to interleukin levels. Researchers found that when topical cooling was given, it delayed the patient's recovery.

Icing was effective at reducing short-term pain, but over time it actually slowed down how quickly muscles healed. The results validated a study done in 1985 that was conducted on rats. In that paper researchers concluded that "icing...might be closely related to a delay in muscle regeneration [and] impairment of muscle regeneration..."

Here's why icing doesn't work. Soft tissue injuries must go through three stages of healing; inflammation, repair and remodeling. If you don't experience the first, you can't get to the second or third.

Since icing a soft tissue injury reduces inflammation, you are essentially slowing down how fast you can heal. That doesn't mean you shouldn't ice an area if a medical professional tells you to, but you might want to ask why.

UPDATE: Researchers confirm Ice therapy doesn't work.

In a study published in the February 1, 2017 issue of the Journal of Physiology, researchers “...compared the effects of cold water immersion versus active recovery on inflammatory cells, pro-inflammatory cytokines, neurotrophins and heat shock proteins (HSPs) in skeletal muscle after intense resistance exercise.” (They tested the differences between using active recovery and cold water therapy.)

After muscle biopsies were analyzed, they found that, “...cold water immersion is no more effective than active recovery for reducing inflammation or cellular stress in muscle after a bout of resistance exercise.” In other words, there's no benefit from submerging parts of your body in cold or ice water over simple active recovery. Ditch the ice bath.

The use and effectiveness of COMPRESSION is a mixed bag. In an ankle sprain, the intent is to reduce swelling. Excess swelling can result in pain and a significant loss of function.

The trick is to make sure compression bandages are applied appropriately. You want to avoid non-elastic bandages that don't flex. They can reduce the blood flow too much, potentially causing ischemia. Use elastic bandages that stay in place, but that can still expand and contract with your muscles.

ELEVATION is the final step to slow blood flow to the injured area. It works as a short-term measure to reduce painful swelling, but should only be done for longer periods under the direction of a physician. Good circulation is critical for long-term recovery and elevation reduces circulation.

Long term strategies for healing include light exercises like dynamic stretching, foam rolling and controlled weight lifting. To deal with chronic inflammation, avoid foods high in sugar and trans fats while concentrating on fruits, vegetables and fish.

Finally, make sure to get enough shut-eye. The hormone that regulates inflammation is called cortisol, and it's lowest when you're sleeping. At the same time, rest increases growth hormone, which helps speed healing by increasing protein synthesis.

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Updated 7/20/2018
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