The very common advice for immediate treatment of an injury is R.I.C.E. — rest, ice, compression and elevation — to reduce swelling. But why should we try to reduce the natural swelling response? When I pose the question on Google, many results merely repeat the details on how, simply assuming that the swelling is a disease rather than a symptom:

Some appear to address the question why, but with circular logic — because ... excessive swelling. Some with "sideways" logic — to stop the pain, but ignoring the fact that there might not be any pain or that the pain may actually be less than the discomfort resulting from applying the ice. Or that chronic swelling can be problematic, but that is a completely different time scale than the recommended application of RICE (months versus hours):

A couple mention the study by Lan Zhou and a team at the Neuroinflammation Research Center at the Cleveland Clinic in Ohio that "found that some inflammation is needed for tissue healing", suggesting that maybe everyone else has got it wrong for all those years.

Do you know of any significant scientific studies that even suggest that suppressing the swelling response to injury speeds or otherwise improves the body's healing process (assuming pain is not an issue)? I'm skeptical.

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    Note, this question skeptics.stackexchange.com/q/7816/18405 is related but asks if or how rather than why. – Martin F Apr 12 '15 at 5:55
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    Welcome to Skeptics! You've asked a tough question, because you have done so much good preliminary research. I hope we can rise to it. – Oddthinking Apr 12 '15 at 9:01
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    I took a pretty bad tumble off my bike a couple years ago, and because of the original swelling and bruising nobody noticed the hairline fracture in my forearm until I went back in for another check two weeks later because my arm wasn't getting any better. – Shadur Apr 12 '15 at 12:43
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    @Shadur - And you're suggesting that somebody would have seen a hairline fracture if only you had reduced the swelling?! – Martin F Apr 12 '15 at 18:10
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    No, but without the swelling they might have noticed that twisting my arm was acutely painful for other reasons than bruising could explain and s er nd me for an X-ray immediately, which would have spotted it. – Shadur Apr 12 '15 at 19:28

From a review article, Acute Ankle Sprain: An Update:

Excessive swelling and pain can limit an examination up to 48 hours after injury.

The American Academy of Family Physicians, the American Academy of Orthopedic Surgeons, and others recommend cryotherapy for ankle sprains, and there appears to be no strong evidence against this therapy.

One study of compression with cryotherapy for inversion ankle sprains suggests that patients with focal compression recover function earlier, but the study was too small to draw definitive conclusions.

compared with placebo, NSAIDs were associated with improved pain control and function, decreased swelling, and more rapid return to activity.

My takeaway is that there are practical reasons to reduce swelling (diagnostics), and some evidence connecting ice and NSAIDs with better recovery.

The two controlled NSAID trials referred to are:

Slatyer MA, Hensley MJ, Lopert R. A randomized controlled trial of piroxicam in the management of acute ankle sprain in Australian Regular Army recruits. The Kapooka Ankle Sprain Study. Am J Sports Med. 1997;25:544–53.

and

Petrella R, Ekman EF, Schuller R, Fort JG. Efficacy of celecoxib, a COX-2-specific inhibitor, and naproxen in the management of acute ankle sprain: results of a double-blind, randomized controlled trial. Clin J Sport Med. 2004;14:225–31.

Another review "Stopping the Spread of Misinflammation", presents a more uncertain summary. It is not peer reviewed, but in my opinion, a fair assessment of the research.

It lists a bunch of studies evaluating either NSAID or cryotherapy and their results. The author attempted to include all human studies involving NSAID or cryotherapy interventions from the previous 20 years. The results are mixed: some studies support their use, others do not. Even if you disagree with the author's interpretation of each study (this is something peer review would have helped check), there are 10s of references to look further into if you are interested.

The conclusion of that review article is that this is an open scientific question, and I agree.

"Acute ankle sprain: an update" did not claim strong evidence in support of cryotherapy, and only mentioned two studies in support of NSAIDs, without stating whether negative studies were sought out. The non-peer reviewed review article found that outcomes have been very mixed. I can't find a more definitive or more recent review.

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