RICE….not just an accompaniment to your Saturday night curry, but the well-known acronym for treating acute injuries (R-rest, I-ice, C-compression, E-elevation). The “ice” element of this approach has come under a lot of scrutiny in recent times. What used to be the “gold standard” for treatment of sprains, strains etc., has taken a bit of a hit. So…next time you twist your ankle, what should you do?
We use ice to reduce inflammation, and as an analgesic (it’s great at numbing those irritated nerve endings!). The argument against icing goes something like this:
“Inflammation is part of the natural healing process, so interrupting it is a bad thing to do”.
Natural… but not Nice
And it’s true to say that inflammation does have a role in healing. It’s part of the immune response, providing a super-highway to whizz white blood cells to a damaged area to prevent infection. That’s its evolutionary reason for existence. Then “cleaning up” cells move in to clear out dead cells, and new tissue begins to form.
There are two types of injury: “septic trauma” (damage with a risk of infection, such as an open wound), and “sterile trauma” (a sprain or strain, where the skin isn’t broken).
In the first case, the immune response is critical. The white blood cells arrive on-site and take out any invaders trying to get in through the wound. Without this, we wouldn’t survive very long. These white blood cells (neutrophils) mean business; they take a “no-risk” approach to invaders. This means they also take out some “own” cells – a kind of collateral damage.
Unfortunately, the immune system isn’t very discriminatory. Septic and sterile injuries get treated in the same way. Neutrophils pile into an area of damage, all guns blazing, even when there are no intruders to kill.
Why? Because, way back in the annals of our evolutionary history, multi-cellular organisms incorporated some very useful bacteria into their cells. These have become part of our cellular machinery, present in each and every cell of our bodies. They are the mitochondria, the tiny power stations that fuel all our activity. We couldn’t do without them.
The problem arises when we get tissue damage (even sterile, internal damage). Mitochondria spill out of broken cells, and the immune system sees them as a threat. They’re still “foreign”, although they’ve been with us a long, long time. They trigger a frankly out-of-proportion inflammatory response. There are no invaders here, no infection risk. Pain does have some value in protecting vulnerable tissue from further abuse. However, the extra pain-producing input from the inflammatory response is overkill – it’s a hiccup in our evolutionary physiology. The point is, not every “natural” process is inherently good or useful – just consider the immune-mediated misery that is hayfever!
Damp it Down…
So although the inflammation of, say, a sprained ankle is a natural response to injury, it’s one we can reasonably quell. And ice is incredibly useful in doing this. It’s cheap and effective, and doesn’t carry the side-effects of medication. It does carry certain warnings (eg. if you have a circulatory problem, skin condition, sensation loss, diabetes) but in most people can be used readily.
Ice is at its most effective if used “raw” against the skin. It’s able to cool the tissue much more effectively this way. There is a risk of ice burn if applied for too long, but if you keep the ice moving over the skin for 2-3 minutes at a time there should be no problem. This should be enough to cool the area until you have a loss of sensation in the skin when you touch it lightly. Let the area return to room temperature, and then re-apply.
You can keep this process going pretty much as often as you can in the first 24-48 hours after an injury; it’s hard to overdo it. Use an ice-cube, or an ice-cup (freeze a paper or polystyrene cup of water, then peel the top edge away to expose a couple of centimetres of ice).
So the anti-inflammatory and analgesic effects of an ice-rub are going to ease the symptoms of your strain, without impeding the healing. In addition to that, don’t forget the other elements of RICE. Compression and elevation are going to help the lymphatic system drain away the extra fluid that’s built up in the tissues. In the early stages, rest is important, too. If you aggravate the damaged area too quickly, you’re only going to injure further cells, release more mitochondria…well, you see where this is going.
After that, gentle mobilisation. Get everything moving as this will help the muscular “pump” system that works the lymph vessels. Movement will also encourage good tissue recovery. New fibres are laid down aligned with directions of stress, so a little movement will get everything lined up nicely and mean stronger healed tissue. Make sure you only move as far as you can without pain to minimise the risk of firing off that inflammatory reaction again. Treat your injury right and it won’t hang around to haunt you.
So get those ice-cups freezing now – you never know when you’ll need them!