Should Ice be Applied for Acute Injury and Inflammation?

Millions of people all over the world know that applying ice to a injured body part is conventional wisdom.  The person who created this conventional wisdom in 1978 is Dr. Gabriel Mirkin [i].  Dr. Mirkin coined the term RICE (Rest, Ice, Compression, Elevation) on page 94 of his book (see first footnote).  Dr. Mirkin’s statements on icing were accepted as gospel, and caught on like wildfire throughout the health care community and general population.  Virtually every western Health Care Practitioner (HCP) on the planet is applying ice to injured or painful areas.

However, Dr. Mirkin retracted his statements about ice in March 2014.  Dr. Mirkin now cites research[ii], ice does not improve healing for inflammation.  Dr. Mirkin now explains that inflammation is the first step in the body’s healing process.  Inflammation attracts a chemical called Insulin-like Glucose Factor 1 or IGF-1, which starts the rest of the healing process.  Ice prevents the attraction of IGF-1 to the inflammation site.  Without IGF-1, the healing process does not start.  Therefore, ice should be contra-indicated for inflammation.

Ice does relieve pain and swelling.  Ice naturally stops many things.  Ice may stop a river from flowing.  Ice can stop bleeding.  Ice stops or delays a corpse from decomposing.  Ice sometimes delays death, consider the experience of people who fall into a frozen lake.  Sometimes after being submerged for 20 minutes or more in icy water, a person can be revived.

When ice prevents the healing process from beginning, it may increase the chances that an acute injury will become a chronic injury.

A note of caution:  if you mention that ice should be contra-indicated for inflammation, to the vast majority of HCPs, the most likely response will be “applying ice is the gold standard approach for pain and inflammation”.  Most likely, they will not know that Dr. Mirkin originated the practice of using ice for inflammation, after all that goes way back to 1978.  Almost certainly, they will not know that Dr. Mirkin retracted his pro-ice statements in March 2014.  If you try to share this information with most HCPs, be prepared for rejection, because the misconceptions regarding ice are “frozen solid” into their mindset.

Dr. Mirkin also changed his position on Rest.  Rather than waiting until the injured area is completely healed, Dr. Mirkin says:  start using the injured area as soon as it can be used, without re-injury.  Using the injured area before complete healing (possibly with the additional support of a brace) will promote faster and better healing.

There is one rare condition that does indicate ice for very severe injuries.  It is called Compartment Syndrome[iii].  Most people will never see Compartment Syndrome in their lifetimes.  However, if Compartment Syndrome does occur, definitely use ice.

What does this topic have to do with Acupuncture?  Chinese Medicine theory never recommends the use of ice for injury or inflammation [iv].  One of my teachers said “the decision to use ice is very simple:  if the patient is dead – use ice, if the patient is not dead – don’t use ice”.

Bottom  line:  ice stops inflammation, swelling and pain, but at the expense of circumventing the healing process.  The trade-off is most likely not in your favor.

So, what should you do for injury or inflammation?

  1. Compression and Elevation are still recommended.
  2. Move the area as soon as it can be moved without re-injury.
  3. Acupuncture is excellent at relieving pain, and reducing inflammation and swelling.
  4. Arnica Montana is a homeopathic remedy, which stops pain/inflammation and promotes healing, for any type of trauma:  accident, surgery, etc.  See your HCP for advice.  Arnica Montana omes in both topical and internal forms.  Larger doses of Arnica Montana (internal form) are available at Hahnemann Labs (
  5. San Huang San is a topical herbal salve, known as “herbal ice”.  San Huang San will relieve pain and swelling, without the damaging effects of ice.  For more information on San Huang San, see this footnote [v].

Dr. Richard Stillo, DACM, L.Ac.

If you would like to comment on this topic, please send an email to

[i] Dr. Mirkin, G., Hoffman, M. (1978), The Sports Medicine Book, Little Brown & Co.  Available on Amazon.

[ii] The American Journal of Sports Medicine, January, 2004;32(1):251-261.


[iv] Deadman, P. (2016), Live Well Live Long, The Journal of Chinese Medicine Ltd., Hove, England. See page 49-50.


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