The Use of Ice For Inflammation: A Prehistoric Approach That Should Be Discontinued

 In Injuries, Tips and Tricks

For decades it’s been common practice to apply ice to an injury to decrease swelling. The research supporting this approach has been very poor, and lately, studies are showing that ice may actually have a negative impact on healing. Why are so many health care professionals still using ice as a first line of defense after a new injury? The suggestion is that ice slows down the circulation to the area and minimizes the accumulation of swelling. Is this the right reasoning and approach for this? Let’s dig deeper into the topic of swelling.

Inflammation isn’t bad!

There it is, we said it – the inflammation isn’t a bad thing. It’s actually a normal process of the human body, so why would we ever try to stop it?! When we injure a tissue, the body will try to remove the damaged stimulus and start the healing process. Part of this process is to increase blood circulation and lymphatic flow to and from the injured area. This allows for healing nutrients and inflammatory cells to the site of injury and help remove the damaged tissue. The best analogy to describe this is “groceries in and garbage out”. Groceries in refers to the fresh blood to accelerate healing and inflammatory cells to clean up the damaged tissue. However, this does increase the fluid to the site, meaning swelling will be present as well as an increased sensation to pain. Afterwards, there will be a big accumulation of waste (garbage) which will need to be evacuated out of the healing area. This is the role of the lymphatic system, it helps remove all the waste and excess fluid build-up caused by inflammation. Let’s find out more about how the lymphatic system is important in the inflammatory process.

The Swelling Highway – The lymphatic system

Our body uses 2 different systems of circulation. The main one being our actual circulatory system, which includes the heart, arteries and veins. The second system is our lymphatic system. The lymphatic system is a one way system of small bags that help direct fluid to the heart and reach the main circulatory system. The unfortunate thing about the lymphatic system is that it has no self-pumping action. The only way that any lymphatic fluid or accumulated swelling can move through the system is by movement and activity of the surrounding muscles. The muscle activity promotes a squeezing effect on the lymphatic vessels and pushes the fluid/swelling towards the heart. Without movement, swelling will stay still and not be evacuated from the injured area.

Why RICE just doesn’t work

RICE is an acronym that was coined to remind people of certain steps to stop inflammation: Rest, Ice, Compression and Elevation. These steps aren’t effective, here’s why:


Rest means that we are immobilizing the injured area, we aren’t moving. However, we now realize that we need muscle activation or movement for the swelling to be evacuated. Clearly, resting an injured area just doesn’t make sense. There was an article published in the American Association of Orthopaedic Surgeons in 1999 entitled ‘Loading of Healing Bone, Fibrous Tissue, and Muscle: Implications for Orthopaedic Practice’ confirming that moving sooner assisted healing. The article concluded that: ‘Although new approaches to facilitate bone and fibrous tissue healing have shown promise, none has been proved to offer beneficial effects comparable to those produced by loading of healing tissues. For these reasons, patients with musculoskeletal injuries and those who have recently undergone surgery are now being treated with controlled physical activity that loads their healing tissues’. To help an area heal we must stress it, and a simple way of doing that is by activating the surrounding muscles. So not only will the muscle activation help move the swelling away, it will actually help improve the healing process as a whole.


The application of ice to an injury helps to slow down blood flow to the area. This decreases pain but at the detriment of slowing down the evacuation of swelling. Since there is a lack of movement (muscle activity) with ice, it creates a back flow of swelling in the lymphatic system. So instead of decreasing inflammation like most people expect it to do, it actually increases it because it isn’t getting evacuated properly.


The purpose of compression is to provide additional pressure to the lymphatic system to help in the evacuation of the swelling. Using this approach by itself will not help to decrease inflammation. We must use it in combination with some light muscle activity, which will help push things up through the lymphatic system and into the general circulation.


This option helps to eliminate gravity, or the pooling of the inflammation in the extremities. But because the lymphatic system needs muscle activity to push the swelling through the body, this option won’t help in getting rid of inflammation, it’s too passive.

What should be the typical course of treatment following sprains or strains?

When we suffer an injury, having a active approach will provide the biggest benefit for healing. This is as simple as some gentle, pain free movement, as it helps maintain function and movement. The new approach has been given the acronym METH, which is Movement, Elevation, Traction and Heat.

METH: Movement, Elevation, Traction and Heat


Since the lymphatic system has no self-pumping action, it relies solely on the activity of the surrounding muscle to push the fluid through. It goes without saying that we do require some form of movement to help get rid of swelling. If moving a limb proves to be painful, applying a muscle stimulator on to key muscles is a good option. This allows for the needed muscle activity, and assist in the flow of the lymph without causing pain.


Probably the least effective option on its own, because it’s passive. However, combining elevation with some movement will assist the flow of lymphatic fluid away from the injured area and can often provide dramatic results.


Traction helps to take pressure off the injured area. Combine this with movement and it’s a winning combination as it increases the amount of fresh blood to the area. Traction with movement also helps to reduce pain as it takes some pressure off of the injured area.


This one is simple because heat helps to increase circulation. This will increase the amount of fresh blood arriving into the area in question. When we receive fresh oxygenated blood, things can heal much better.

Inflammation Good, Ice Bad

To sum things up, inflammation is a normal thing and we need it to heal an injury. However, ice does not reduce inflammation, it actually makes it worse by creating a back flow of fluid in the lymphatic system. The only thing that ice is useful for is numbing a painful area, or keeping a drink cold. If you want to help the body heal, think of METH – movement, elevation, traction and heat.

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Showing 10 comments
  • Deo

    Yes but. After a few minutes (7-15) of ice you will get an reactive hyperhemia and you will get an acceleration of the blow flow. And there is a lot of references for this.

    • Bellefleur Physiotherapy

      Yes, that might help with blood flow, but the lymphatic system still won’t be able to push through the swelling. You need controlled movement to be able to do this. Ice by itself doesn’t help to get rid of swelling.

  • Ben

    Hi! Great job! Did you’ve got more literature on this subject? or link to some references? Thanks, Ben.

  • Steve

    This is absolute stupidity and a serious dis service. Its stuff like this that makes people question physio. I get it that you have your opinion but seriously to flaunt it in a public way and mislead decades worth of real science.

    • Bellefleur Physiotherapy

      Hi Steve,
      Thanks for the feedback, we really appreciate your passion surrounding this topic. Below are a few links that you may find of interest. Unfortunately, ice has been a mainstay on the playing field and for acute injuries because of assumptions made in the 70s that were never confirmed scientifically.

      Bahram Jam – one of the leaders of continuing education for Physiotherapists in Canada –
      Kelly Starrett (Mobility WOD) speaking with Gary Reinl –
      McLean’s Magazine discussing new research around icing injuries –
      Quotes from studies confirming that there are no clinical studies proving that ice helps inflammation –

      The unfortunate thing with the physiotherapy profession is that it often stays stuck in time, even with evidence suggesting otherwise. We are happy to chat about this more, increasing awareness is a great way to move things forward.

    • jack healy

      Good job, I have been going on about this for years, people hate change The science of mechanical loading stimulates repair has been around a long time ,also tendons stay cold for very long periods of time post icing which can also compromises recovery.

  • Steve Traynor

    I don’t understand what you mean by traction. Could you elaborate? I’ve just had arthroscopic surgery on my knee and had my doubts about icing and anti-inflammatory meds.

    • Bellefleur Physiotherapy

      Traction means separating the joint surfaces, one from the other. This helps to take of pressure of the joint surface, relax some of the surrounding tissue and often allows for easier mobility. Here’s a video for knee traction:

  • Fisiokit

    Thank you!

    I have been a physio for 10 years and always struggled with the concept of icing and anti-inflammatory medicines. Great article.

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