To ice or not to ice…

Canadian Physiotherapy Association


Things are changing with respect to the use of cryotherapy in acute injuries, and the way we use ice in physiotherapy practice. There has been some very good research done over the past decade or so indicating that RICE or PRICE may not be as effective as we once thought in the acute stage of injury. There have been several articles published that help explain the move away from significant cooling.

The use of ice in the treatment of acute soft-tissue injury

Ice and modern sports physiotherapy: still cool?

PRICE needs updating, should we call the POLICE?

The method of application of cryotherapy may also play a role. In one article, an intermittent application of cryotherapy (10 minutes on, 10 minutes off, then 10 minutes on again – then left off for 2 hours. When compared to the 20 minutes on, 2 hours off regime, the intermittent application group had less pain on activity than the continuous group. Also, some suggest that cooling with elevation and compression (i.e. with a cryocuff-type device) may be better than colder crushed ice application.

The use of cryotherapy for pain control can still be effective – if the primary goal is to reduce pain. However the application need not be too long – 5 to 10 minutes is often sufficient to decrease acute pain.

Many of us were taught that ice was the best thing to use in acute injury, and that many still hold that belief. However there is enough evidence today to suggest we move cautiously away from significant cooling, to more moderate cooling, at the most appropriate time, and using the most appropriate methods.

What do you think? Tell us your thoughts in the comment section below.