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It has been taught for a long time (and appears to be mainstream "knowledge", such as documented here in Wikipedia) that applying an ice pack to an injury reduces the severity of swelling, and it also seems to be taught (by implication, at least) that reducing swelling is a good thing.

Does cooling an injury really prevent swelling? (slowing it doesn't count - I think we can accept that much is true)

Is preventing swelling a good thing? (This article appears to say some swelling is good: "For wounds to heal we need controlled inflammation, not too much, and not too little", but maybe that just means one shouldn't use too much ice?)

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    Wow, I thought this would be an easy and quick one, but the Cochrane Collaboration have nothing, Wikipedia has "citation needed", and there is even some controversy over the technique. Looking forward to seeing what other people find. – Oddthinking Feb 3 '12 at 6:24
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    you do confuse things. Using ice to control inflamation (which is logical, ice cools the affected area) and swelling (which is a result of the inflamation) being reduced. And of course whether preventing swelling is good or bad, which has nothing to do with whether ice will reduce swelling or not. – jwenting Feb 3 '12 at 7:20
  • @jwenting: Are you are saying there is a difference between "inflammation" and "swelling"? Interesting; can you please explain further (refs?), because I didn't understand your distinction. – Oddthinking Feb 3 '12 at 12:11
  • the swelling is caused by fluids concentrating in the area, which is in itself caused by the inflamation (damaged tissue) and the body's attempts to heal that. Learned that in first aid class some 30 years ago. – jwenting Feb 3 '12 at 12:32
  • Maybe it depends on the type of swelling? Heat for muscles, cold for joints. That kind of thing. – GEdgar Jun 8 '15 at 14:29
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There are a number of studies which show that applying ice (cryotherapy) helps reduce swelling. This link deals specifically with applying ICE (Ice, Compression, Elevation) to ankle sprains. Evidence-based first aid courses such as those taught by the Red Cross all agree that using ice should be the first action taken when dealing with certain injuries.

From the previous document:

The therapeutic use of cold produces many physiological effects. Cryotherapy is commonly accepted as the standard treatment in the management of acute injuries in order to inhibit inflammation. However, inflammation is a complex set of events that only becomes more complex when looking at the specific effects of cold on inflammation. Inflammation can be described by its vascular events, chemical events, and cellular events since acute cryotherapy affects all three of these. Vasoconstriction due to cold therapy counteracts the vascular events of inflammation, specifically vasodilation. Cryotherapy also affects the release of over 100 chemicals that mediate the inflammatory process through the chemical events of inflammation. Despite the effects of cold not being researched for most of these inflammatory chemicals, the release or activity of several of the key inflammatory chemicals is known to be inhibited as a result of cryotherapy.

From my own experience as a paramedic and training as a paramedic and first-aid teacher: Vasodilation (the expansion of blood vessels) is a common effect in injuries such as sprains and can even occur to such an extent that the patient briefly faints due to a blood pressure drop. Ice causes vasoconstriction (the tightening of blood vessels) which reduces the effect vasodilation has. Vasoconstriction reduces the amount of blood lost internally by limiting blood flow and inhibits the forming of edema, reducing overall pressure on the affected area. Ice also has the obvious advantage of numbing the affected area, reducing the pain initially felt.

Note that ICE (Ice, Compression, Elevation) is typical for first-aid scenario's. If a patient has ICE applied and it does not help after the first 20 minutes of cooling down a physician should be consulted. This is also the reason for the 'controversy' surrounding ICE: certain types of injury and mechanisms of injury do not respond well to ICE and should be treated differently. A fracture or ligament tear for example will respond to ICE by reducing pain and swelling but - for obvious reasons - cannot be treated by ICE alone. ICE is not a magic bullet, it's a guideline to provide first aid and the outcome of ICE will determine if a patient might need to see a physician.

  • The study linked to in this answer is not longer present, unfortunately, although Google still has it cached. It seems to be named "ELEVATION: RETARDING EDEMA FORMATION IN THE ACUTE LATERAL ANKLE SPRAIN" by Jason Hageman – Highly Irregular May 4 '12 at 20:41

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