Has Icing Injuries Fallen Out of Favour Because it Prevents Inflammation?

Posted on October 25, 2023 by Categories: Cryochaps
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Most horse owners will have at some point cold hosed or iced their horse’s legs after an injury – and many riders have reached for an ice pack after an unexpected dismount! Icing injuries has been a common practice for many years in the treatment of acute injuries like sprains and strains. The primary purpose of icing is to reduce pain and inflammation in the injured area by constricting blood vessels and slowing down the inflammatory response. However, there has been some evolving understanding in recent years regarding the use of ice in injury management. This blog article outlines what the research says about icing and soft tissue injuries.

The Debate Around Icing Human Injuries

While icing is still a widely used technique, there has been debate and discussion among human healthcare professionals and researchers about its effectiveness and whether it may potentially slow down the body’s natural healing processes by excessively reducing inflammation. Inflammation is a crucial part of the body’s healing mechanism, so could too much icing hinder this process? Looking into the published data, there appears to be a trend to efficacy related to the specific type of soft tissue injury: muscle, versus, ligament versus tendon.

Icing and Tendon Injuries

The tendon, which can be seen as bands of fibrous tissue that connect muscles to bones, could help our muscles initiate and control different movement in joints. When the tendon is suddenly overstretched or torn, strains could happen. Immediate treatment including icing the injured area for a time is always recommended to reduce the pain and swelling after acute traumatic injuries. Evidence supports the view that the ability of cold treatment to reduce pain for acute tendon injuries may be attributable to its ability to decrease the levels of prostaglandin E2 production in tendons, which is a highly active inflammatory molecule that causes pain and induces vasodilatation and hyperalgesia.

Icing and Ligament Injuries

Being similar to tendons, ligaments are also fibrous bands of connective tissue, and generally play roles in stabilising the skeleton and allowing controllable movement. When a sprain occurs, the ligament around the joint would tear. Sprains in the ligament are classified by several grades, and for the minor level of symptom, cold therapy could have the ability to reduce swelling and pain in a short time. A general range of time frame for ligament healing is around 10-12 weeks, which is longer than that of the muscle and tendon.

Icing and Muscle Injuries

For muscle, while cryotherapy works by reducing blood flow to a particular injured area, it could reduce the muscle spasms and muscle soreness, and ease pain. The general range of time frame for muscle healing is around 2-4 weeks, which is relatively short because of its rich blood supply. It is therefore important to activate its circulatory system to encourage healing after injuries and promote regeneration of the damaged muscle fibres. Therefore, the cold application on acute muscle fibre injuries should not last long and needs to be controlled precisely to avoid harming the neuromuscular muscle function.

So, To Ice or Not to Ice?

As a result of the evidence around the effects of cryotherapy on different types of soft tissue, the use of ice in injury management has become somewhat controversial. There is the blanket idea that icing inhibits inflammation and that delays healing. However, that may be only pertinent to muscle injury.

Injuries to the horse’s lower leg tend to be specific to ligaments and tendons (remember that there are no muscles in the horse’s lower leg). Furthermore, there is evidence to say that minimising the swelling can benefit recovery. Should we therefore have more individualised approaches to injury treatment in horses? 

Some experts advocate for Rest, (box rest) Ice and Compression. However, certainly in the human side “MEAT” (Movement, Exercise, Analgesics, and Treatment) that emphasise early movement and controlled exercise along with icing may have more benefit.

The choice to ice or not to ice an injury may depend on factors such as the type and severity of the injury, individual preferences, and the advice of your vet. It’s essential to consult with your vet for guidance on the most appropriate treatment for your horse’s specific injury. However, icing when there is significant swelling and heat may be beneficial when waiting for the vet to arrive!