This post aims to shine some light on the evidence surrounding using ice as a treatment method for acute injuries.
The History of Injury Management Guidelines
The guideline RICE (Rest, Ice, Compress, Elevate) for acute injuries is about 50 years old. We have all learned to apply this when we get hurt – whether an injury on the footy field or a twisted ankle at the beach.
This recommendation was updated to PRICE (Protect, Rest, Ice, Compress, Elevate) and about 10 years ago, POLICE was introduced. ‘Rest’ was replaced with ‘Optimal Loading’, encouraging gentle, tolerated loading of tissues instead of full rest and immobilisation of the injured limb.
In 2019, the updated acronyms PEACE and LOVE then emerged after research was conducted.
Understanding PEACE & LOVE for Injury Management
What is PEACE?
PEACE is recommended to apply in the acute stage, which is the first 48 hours after soft tissue injury has occurred.
PEACE stands for:
Protection
Elevation
Avoid anti-inflammatories and ice
Compression
Education
Breaking Down PEACE: What Each Step Means
Protection – Avoid overloading the tissue that has recently been injured
Elevation – Elevate the injured limb as often as possible higher than the heart level
Avoid – Avoid the use of anti-inflammatories (NSAIDs) as these delay the healing process in tissues after injury. According to the latest research, there is now no benefit from taking these. Additionally, ice (yes you read that right!) is related to potentially delaying the healing process after a muscle tear or ligament injury.
Compression – Use compressive bandaging or strapping to limit swelling and support the injured tissue
Education – information about the expected rate of recovery and healing time. It is normal and expected that soft tissue injuries may take a number of weeks to heal… so be patient!
What is LOVE?
LOVE injury management recommendations follow after the acute phase, so the period is 48-72 hours after injury. These letters stand for:
Load – Apply gentle, tolerated loads to injured tissues guided by pain. Your body will tell you when it is safe to increase the load (or you can ask your physiotherapist)
Optimism – Your state of mind is associated with pain and disability levels, not just the grade or severity of your injury. Stay positive!
Vascularisation – Aerobic exercise and keeping physically active assists your injury to heal.
Exercises – Strengthening, range of motion and proprioceptive rehabilitation are necessary to assist the tissue to fully recover from injury.
Does Ice Help Heal Injuries?
The Truth About Ice for Acute Injuries
Ice is still very commonly used even though there is minimal evidence that it will speed up recovery and reduce pain levels. If you think about it, pain after an injury is normal – it is your body’s way of telling your brain that you’re overloading the tissues. So, it is a helpful message!
However, if pain is a barrier to your recovery and is limiting physical activity, and you have found that applying an ice pack helps, that is completely fine to do. Whilst there is minimal evidence that ice is beneficial, it does not do any harm either.
When Might Ice Still Be Useful?
If you have just had surgery, for example, a knee or hip replacement, there is evidence that applying ice in the first 24-48 hours helps to reduce the use of opioids and pain medication. However, this is the only evidence found in current literature in relation to the benefits of using ice for acute tissue injuries.
Final Thoughts: Should We Stop Using Ice
Using ice initially is still OK, if you find that this helps. However as discussed, whilst it has no risks associated it will also not help you heal any faster. As a physiotherapist, I would not recommend consistent application of ice on an injury after the first 24 hours, unless I have discussed this with a patient, and they find it helpful. If you find that using heat instead of ice helps, this is completely fine too! You can try both to see which one works better for you.
So, should we stop using ice? It is not harmful, but there is no evidence that it assists acute soft tissue healing. The bottom line is if it helps you move better and sleep better, then go ahead 😊.
Contact us at Albany Physiotherapy for more information about PEACE & LOVE today!
