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  • Richard Johnson

Using ICE in acute injuries, why the confusion?




All First Aiders will know how to treat Soft Tissue Injuries using the RICE, PRICE, PRICER or PRICED principles:

Protect Rest Ice Compression Elevation (Refer) (Doctor)


In the Sports Therapy/Sports Medicine Profession there has been lots of conflicting and confusing information on using Ice on acute soft tissue injuries.


Hopefully I can clear up a little of the confusion, and give the difference between what we do as Sports Therapists, and what First Aiders do.


In First Aid, RICE is still the First Aid protocol for soft tissue injuries, and whilst I have always had some issue with this, if it is done correctly, there should be limited interference with the body's own natural healing process.


I am not a big fan of wrapping ice bags over an injury, as in the image above. I think this has the potential to cause more issues with the healing process, and even the potential to cause harm, as in many cases the ice is left on the area far too long.



My preferred use of Ice is for pain relief, and an easy and manageable way to achieve this is by the 'ice cup massage method'. I've found that just a few minutes of this can produce some good analgesic effects (better than the freeze sprays etc), without interfering with the natural healing process. A simple disposable ice pack, which is cold for about 5 minutes is also useful and again, doesn't have too much effect on the inflammation process.


So that's First Aid on acute soft tissue injuries, but what about Sports Therapists, what can we do?


The POLICE acronym has been adopted by many health professionals since it was published in BJSM in 2012 (though used by many professional sports therapists for many years).


What does POLICE stand for?

Protect - (from further injury) Optimal Loading - (see below) ICE - ( a few minutes for analgesia) Compression - (or comfort. Elastic Cohesive Bandages are good for this, as they don't cut off circulation) Elevation - (to assist the lymphatic system)


Optimal Loading doesn’t mean getting someone to use maximal force through an injured limb straight away and some people do think that includes things such as massage therapy and strength training, which I would be dubious about teaching or using in a treatment, but what it does mean in my opinion, and what I have been teaching for years, is that careful mechanical loading during the inflammatory stage can have a positive influence on healing.


Note the word careful here, it should be done in a controlled manner. Optimal Loading can mean the use of gentle manual therapy such as Soft Tissue Mobilisation as well as (in the case of lower limb injuries) walking aids.


The POLICE protocol is best started 24 hours after injury has occurred.


Remember also the HARM acronym! What to avoid;

Heat Alcohol Running (Exercise) Massage


Using the HARM protocol in conjunction with POLICE means that really, you aren’t going to make the injury any worse. For those who think that Optimal Loading in an Acute Injury means strength training and massage this means you.

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