You may have heard people say to use RICE when they injure themselves (Marieb [2004]). It stands for Rest, Ice, Compression, Elevation. Everyone knows about resting an injury (even though we often carry on and ignore it). Compression and Elevation make sense for limbs if we want the inflammation to settle, but why Ice and not heat?

Have you tried it for yourself?

Well, next time you hurt yourself, and think it just a strain or sprain, why not try it to reduce swelling and pain (St.John Ambulance [2002])? Wrap ice in a tea towel, apply for 3-10 minutes then rest for 20 minutes. Then repeat until bored…do this particularly in the evening, when you are not going to use the injured muscles/tendons much more.

Do NOT try this if you think you have fractured a bone – it is “contraindicated” because bones need blood supply to recover. . Also, do not use ice with burns – cold water only is indicated – you don’t want to lose too much bodyheat with a burn (Fisher[2006]).

It is important to seek medical advice if you think the injury is more than trivial.

Healing and Over-use

The thinking, it seems:

1. Inflammation is a necessary first stage in healing. Histamine is released by “mast” cells in response to damage. This makes the capillaries around “fenestrate” – become full of holes like colanders, so lots of fluid floods the area. This brings nourishment to help repair, and slows movement of fluid to reduce the spread of infection. White blood cells travel upstream to the area, attracted by the inflammatory chemicals, to eat damaged tissue and bacteria. Inflammation also is good for an “acute” (recent) injury because it reduces mobility, lessening the chance of further damage.

2. However, there is not much movement after the initial flush of blood, which would reduce the spread of infection. Further healing can slow down: no more nourishment is coming to the area, and dead white blood cells & debris are not being removed.

3. With repetitive strain (aka “overuse injuries” include RSI, carpal tunnel, tennis elbow, golfers elbow, etc), where the tissue is damaged again and again before it heals, a low grade “chronic” (long-term) inflammation sets in, where the body has repeatedly tried to heal, but then moves from “repair” to “containment”.  All sorts of pathological complications arise, and many debilitating and even life-threatening conditions arise from chronic inflammation. At the very least, there is a constant build up of collagen laid down randomly (and if you don’t exercise the area gently somehow, it will not be laid in the right lines of force, becoming fibrous adhesions gluing everything together)

How does Ice help?

It is thought that icing will contract the branching blood vessel capillaries, allowing pressure to reduce and allowing movement of fluid into the lymph ducts, forcing blood and debris from the area. The lymph will filter this fluid, and get rid of debris.

As the area warms up again, fresh blood with fresh nourishment comes in. However, without the inflammation reducing mobility, there is a risk of further injury, so it is good to rest for 30 minutes after.

Keep repeating several times during the day, to give yourself an “oil change”. 2 minutes at a time on bony areas, up to 5 on fleshy areas – long enough to make the skin pale, but not so long it goes red again (that is counter-productive – the body has said to itself – “heck it is cold, I better adjust to make sure the tissue gets oxygen)…

Make sure you wrap the ice in a tea towel so you don’t burn the skin (Read & Wade[1997]).

Check what other people say

Check the internet to see – try “strain” on Wikipedia. A “strain” is damage to a muscle or tendon, a “sprain” is damage to a ligament.

Icing can be tried for any injury, because there is almost always a soft-tissue component to the damage and usually inflammation

So, why not heat?

If you apply heat to a recent injury in the first 48 hours or so, you will aggravate inflammation, and risk more pain and slower healing (Peterson & Renstrom[2001]).

Heat alternating with ice can help in the “post-acute” stage, 48 hours plus after the injury, if the inflammation has already settled down. It can help to reduce spasm in tense muscles, and therefore reduce pain.

Of course, this article is no substitute for consulting a properly qualified medic – as bodyworkers, we are not allowed by law to prescribe or diagnose. However, as First Aiders, we are allowed to use water and ice, and can give general “wellness” advice.


Fisher, S [2006] The Book of Medical Emergencies, London, Carlton Books, ISBN 1 84442 273 9 page 55

Marieb E [2004] Human Anatomy & Physiology, 6th Edition, San Francisco, Pearson Education Inc, ISBN 0-321-20413-1, page 319

Peterson & Renstrom [2001] Sports Injuries, Their Prevention and Treatment 3rd Edition, London, Martin Dunitz, ISBN 1 85317 119 0, page 97

Read M & Wade W [1997] Sports Injuries 2nd Edition, London, Elsevier Ltd ISBN 0 7506 3112 0 page 25

St.John Ambulance[2002] First Aid at Work, 5th Edition, London, St.John Supplies, pages 250-251