It’s Saturday morning and you’ve just come down on the side of your ankle while playing in the neighborhood basketball game. The pain is immediate as you limp to the sideline. “Get some ice,” someone yells. You lie down, put your leg up on a chair and wait for the ice. Upon arrival you wrap the ice tightly around the ankle. You have just satisfied the age-old rule of RICE, the recommended treatment for acute injuries for 46 years. RICE stands for rest, ice, compression, and elevation, all factors designed to reduce blood flow as well as inflammation. RICE was first proposed by Harvard physician Gabe Mirkin in his 1978 text “The Sports Medicine Book.”

Upon publication, almost every training room in the United States ordered an ice machine, treating the slightest injury with ice. Pharmacies stocked instant ice treatments for everything from sprained ankles to knee replacements. We see professional athletes wrapped in ice and sitting in ice baths. With all this use, there must have been a lot of medical science supporting ice treatments. But that wasn’t the case; ice had been used in medicine but mostly to support limbs during amputation.

The primary theory for reducing blood flow following acute injury was to minimize inflammation. Inflammation seems to have a bad reputation, perhaps because inflammation is associated with more systemic problems such as Parkinson’s and rheumatoid arthritis. Inflammation sounds like the body is in flames; ice cools heat. But inflammation is simply the process of rushing white blood cells to the site to prevent infection and remove dead tissue. Inflammation is the first stage of healing. Since ice slows inflammation, one might ask, why try to slow it down?

Currently, the rampant use of ice is highly debated in sports medicine literature. Confounding the issue is the fact that ice also relieves pain and reduces swelling. There is no clear answer.. Also, the literature does not address the fact that not all injuries are the same. Perhaps, ice may be called for in some cases but not in others. Some sprains may result in severe swelling while others may not. A serious ankle sprain can result in intense swelling as the result of damage to soft tissue. Swelling reduces mobility and takes time to reduce. Immediate (but not long term) ice may be good in such cases. But what if you just tweak your ankle or knee, causing some discomfort but not serious swelling? In such cases, I’m forgoing the ice.

What about muscle strains or tears? Since strains do not occur in the joint, and more toward the middle of the muscle, joint mobility is not significantly compromised with swelling. There will be some discomfort but if you can withstand discomfort, many therapists are not recommending ice applications. Also, Tylenol is the analgesic choice since drugs like Advil or Ibuprofen are anti-inflammatory drugs.

Rest is another treatment that has come into question. The injury and the healing process results in swelling. Reducing swelling helps healing so keep moving. Swelling is removed through the lymphatic system, but the lymphatic system is passive and needs help to flow. Not only do muscular contractions facilitate the system, stimulate blood flow to decrease the swelling, muscle atrophy is avoided. Movement should be pain free; you don’t want to continue to hurt the injury. In some cases, movement is too painful or restrained. In such situations, many physical therapists use neuromuscular electrical stimulation.

Strenuous or unfamiliar exercise usually causes muscle soreness? Can ice prevent muscle soreness? No. We used to do studies on this in my laboratory at Smith College. Icing didn’t help and sometimes hurt. Muscle soreness is caused by small muscle tears. What happens when you get small muscle tears — inflammation. What about ice baths? Does it help recovery? They are not injured and are probably engaging in activities they have adapted to. Whether this helps or not is unclear. Many athletes feel that it helps and that outcome alone may support the use.

What’s a person to do? First, don’t run to the freezer every time you get a little injury. Also, you don’t need to ice yourself after exercise. Let any healing run its course. If you’re injured, try to keep moving, not by returning to competition but by mild to moderate exercise. Feel free to protect the injury. Second, if swelling or pain is overwhelming, apply ice but not long term. Finally, try not to use ice for muscle strains but keep moving.

Jim Johnson is a retired professor of exercise and sport science after teaching 52 years at Smith College and Washington University in St. Louis. He comments about sport, exercise, and sports medicine. He can be reached at jjohnson@smith.edu.