RICE: Yes or No

[physiomitch]

I hear what you are saying. Gels unfortunately do do what you say, they also contain Isopropyl alcohol (cooling agent) a known carcinogenic! I agree patient feedback is necessary, but if it was explained to them that ice could be harmful in the long-term, maybe they would refuse it anyway, and rely on natural means of easing the pain, like rubbing, gentle movements etc. As Physios I believe it is our job not to worry too much about the chemistry but concern ourselves with removing any obstacles getting in the way of the body healing itself. Granted a little pain relief can be beneficial, but maybe in smaller doses as I mentioned. I use this approach for my local rugby team and get fairly good results. I believe the fact we can feel the symptoms, gives us a better idea about how the body is dealing with it. Remember the body has access to endorphins 50+ times stronger than morphine, so if it feels it needs them it will activate their release. I have seen a drunk guy black out 1 minute after being hit in the ankle by a passing car, but he managed to get to the other side of the road and sit down first, then...poof! I just think there needs to be a little more research into this as far as aiding repair, not just treating symtoms.

Cheers

Pete

[Canuck Physio]

Here is some very recent evidence:

OBJECTIVE: To determine if ice-water immersion after eccentric quadriceps exercise minimises the symptoms of delayed-onset muscle soreness (DOMS). DESIGN: A prospective randomised double-blind controlled trial was undertaken. 40 untrained volunteers performed an eccentric loading protocol with their non-dominant leg. INTERVENTIONS: Participants were randomised to three 1-min immersions in either

• ice water (5 +/- 1 degrees C)
  or tepid water (24 degrees C)

. MAIN OUTCOME MEASURES: Pain and tenderness (visual analogue scale), swelling (thigh circumference), function (one-legged hop for distance), maximal isometric strength and serum creatine kinase (CK) recorded at baseline, 24, 48 and 72 h after exercise. Changes in outcome measures over time were compared to determine the effect of group allocation using independent t tests or Mann-Whitney U tests. RESULTS: No significant differences were observed between groups with regard to changes in most pain parameters, tenderness, isometric strength, swelling, hop-for-distance or serum CK over time. There was a significant difference in pain on sit-to-stand at 24 h, with the intervention group demonstrating a greater increase in pain than the control group (median change 8.0 versus 2.0 mm, respectively, p = 0.009). CONCLUSIONS: The protocol of ice-water immersion used in this study was ineffectual in minimising markers of DOMS in untrained individuals. This study challenges the wide use of this intervention as a recovery strategy by athletes.
Author/Association: Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R
Title: Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial [with consumer summary]
Source: British Journal of Sports Medicine 2007 Jun;41(6):392-397

[Canuck Physio]

However, having said that, it appears that other evidence shows that Contrast Ice Water therapy is effective at decreasing DOMS, and increasing Power output capacity post Exercise!