Should we stop icing our injuries?

Icing is a popular self-treatment strategy used by both sportsmen/women and non-sporting populations to decrease pain and accelerate healing. Ice is regularly recommended alongside rest, compression and elevation. This protocol is called “RICE” forming an acronym.

In theory, rest prevents stress on the injured area, ice reduces the temperature of the tissues to reduce inflammation, compression and elevation both work to limit the bleeding and swelling of the tissue. But how much research is there to suggest that this theory is true?

Three ice cubes on white background.

The reality

In 2012 Bekerom and colleagues wrote a paper titled: “What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?”. Ankle sprains were used in this research as they are the common acute injury and therefore are normally the area in which ice is applied to. The study found very limited effectiveness of the RICE protocol. In fact, there is more research to suggest that early movement (“mobilisation”) is effective to reduce swelling as opposed to rest. In terms of ice in particular, there was not enough positive or negative results to make an informed conclusion.

Why could the RICE protocol not be effective?

Some researchers have suggested that ice can work against the body’s natural healing process. During an injury the body goes through some distinct processes: bleeding, inflammation, proliferation and remodelling. Ice attempts to reduce the bleeding and inflammation stage which are necessary to the healing process. If ice then reduces these, is it working against the healing process?


The RICE protocol has little evidence to support its use and people should not use this protocol as a self-treatment technique. In the early stages of a traumatic injury you should focus on early movement and weight bearing as you are able, ice may help to reduce the pain, but it is unlikely to impact on the healing process.

Is Warm Up Necessary?

The theory

The idea of warming up before physical activity has been utilised for many years by both elite and recreational sportsmen and women. Warming up is generally performed with a short bout of aerobic (light exercise) activity such as a five minute jog followed by stretching and then sport specific drills. This is theorised to physically warm muscle tissue to prepare it to contract quickly and forcefully, to speed up nerve transmission from the brain to the muscle and to psychologically prepare the athlete for the sport. It is proposed that warming up can help prevent injury, reduce soreness and improved performance, however, theory and scientific evidence don’t always agree and in this article I will examine if warming up is actually necessary.


Does warming up prevent injury

In theory, the warm up period would heat the muscle tissue which would literally make the muscle more elastic and ready to contract forcefully without the risk of tearing. Imagine a warm vs a cold elastic band, the colder elastic band would be easier to break which in this case would be a pulled muscle and resultant injury.

In 2006 a study by Fradkin and colleagues which was titled “Does warming up prevent injury in sport? The evidence from randomised control trials?”. The study concluded that “there is insufficient evidence to endorse or discontinue a warm up prior to physical activity”. However, the study did note a slight trend towards warming up reducing injury.

Interestingly as the previous publication shows, there is not enough evidence to recommend warming up to prevent injury. However, the Fifa 11+ is a warm up programme for footballers designed to reduce the risk of knee ligament injuries and this has been found to be very effective. Although, this may have been due to the hip strengthening component as opposed to the actual act of warming up itself.

Does warming up reduce DOMS

“DOMS” or “delayed onset muscle soreness” is the soreness that you feel after going to the gym for the next day or two. The actual origin of DOMS and its cause is contested but it is theorised to be because of eccentric loading (the lowing section of a bicep curl, for example). DOMS is a common issue among sporting population as having DOMS reduces muscle power and therefore reduces performance and increases recovery time.

In 2012 Olsen and colleagues examined whether a warm prevented DOMS in the quad (front of thigh) muscles. The warm up proposed was 15-20 minutes of cycling which completely warmed the muscle tissue. The study did find a trend towards decreased DOMS in the warm up group, however, this was only a small trail of 36 participants and is far from conclusive.


Does warming up improve performance

Warming up has been theorised to improve performance by again warming up the tissue to prepare for contraction and the psychological action of warming up may also prepare the athletes mind to compete.

A study Andrade and colleagues in 2015 showed a trend towards an improvement in performance if the warm up was specific to the activity being done after it. However again, this trial only examined 10 participants which is an insufficient number for concrete conclusions to be made.



There is insufficient evidence to suggest that warming up is beneficial. However, warming up, if done correctly is never going to cause harm. In my opinion, it would be prudent to continue warming up, unless new studies specifically show no benefit.


If you choose to warm up, what should and shouldn’t be included

In general, a warm up should be specific to the sport you are taking part in. For example, if you are preparing to run a sprint, then stretching should be done in a dynamic fashion (stretching with movement such as butt kicks or high knees). In contrast to this, if you are preparing for Yoga, you may start with some static stretching (not moving such as a basic seated hamstring stretch) to prepare for deeper stretching during the class. It should be noted that for explosive sports, such as weightlifting and sprinting, static stretching should be avoided. Static stretching relaxes the neuromuscular system when in reality you would want to wake up this system before performance. In fact, relaxing the muscle system before an explosive activity may lead to an increased risk of injury as the person would gain more movement from the stretching and therefore work outside their “comfort zone”.

In general this should be an outline for a warm up:

  • 5 minutes aerobic activity (running, cycling etc)
  • 5 minutes stretching (dynamic or static, must be specific)
  • 5 minute Drills (footwork drills for football, for example)
  • Warm up should take no longer than 15 minutes and should not include activities that are high in intensity

What is the best exercise for you?

The difficulty lies not so much in developing new ideas as in escaping from old ones.

John Maynard Keynes


Perhaps you have tried many different sports or maybe you have done exact the same training for the past two years. Whatever you are doing now, jumping, running, jogging, cycling, rowing, stop for a minute and think: what is the best exercise? What is the best exercise for ME?

They are two very different questions: the first one is more academic, the second one is more pragmatic. In this article I will only treat the second one. You can consider this an introduction to the first one, that I will treat in the next article, here, for J&P.

You should consider three aspects, if you want to find out if you are doing the best training for yourself: your past, your present and the future. Always start with looking at your present conditions: what is my age? Am I happy of myself? Am I doing a sport that makes me feel good or is it a pain every time I put my trainers on? How much time do I have to dedicate to exercise? How important is exercising for me? Of course, it is very different if you are in your 20s or in your 50s. It is not only a matter of performance. It is a matter of recovery time. You can’t hope to do the same training 6 times a week and avoid overtraining (unless you are doing 15 mins of slow jogging/walking a day in the park).

If you want to reach a good level of health and fitness, learning to rest is the first rule. Hey! I did not mean that… get up from that couch! There are many ways to recover. Just remember that your current condition matters. And here it is important to introduce that “past factor”: if you have never done sport or you haven’t done any exercises for the last few years and you want to restart, a medical check-up is the first thing to think about. If you are an athlete, you know that a yearly medical screening is required; but even if you just jog in the park twice a week, I suggest doing it every two years. We all get older and prevention is the first thing to choose the correct activity for you.

Ok, now that you know that you are fit for sport, the problem remains: what to choose? Three things are important here, sit down and think: what is your passion, how much time do you have and what is your purpose? You can write it down on your diary, on a blackboard, on your smartphone, on the back of your white cat… but write it down! If you have 10 minutes a day, but your passion is bodybuilding and you want to become Mr Olympia… maybe it is a little bit too pretentious. If you are telling me that you do not even have 10 minutes a day for yourself… you have other problems than training. Include in the time of your training also the time to go to the gym, to drive to the park, to change your clothes, to have a good shower at the end. And then think about the goal: why are you training? What do you want to achieve? Are you just following your passion? Would you like to lose weight? Would you like to look fitter? Do you want to run a marathon or raise 220 Kg in deadlift? Do you want to have big muscles to impress other people? Or, you just want to play 5 a side with your colleagues?

Passion is important, but it is not the solely thing to consider, especially if you start to have some physical problems: I am not saying that you should forget that weekly football match with your friends if you have some knee pain or that you should avoid golf if you have back pain, but it is better to add some exercises during the week to strengthen your body and prevent injuries as much as possible. Then you should consider the best combination of time and purpose for you. For example, you want to lose some weight, but you have only 20 minutes in the morning. Well, my suggestions are 2: find a space in your house to do some calisthenics and check your diet. With the modern technology it is not necessary to go to the gym to follow specific programmes. If it is the first time you do it, I suggest seeing a personal trainer or a physiotherapist to have some ideas about it. If you are already expert, you know that there are many short work-outs on You Tube or programmes that you can follow. About dieting: it is unlikely that you can reach your goal without a good diet. I am not a nutritionist, but dieting is as important as exercising if you want to lose weight, especially if you are not in your 20s anymore.

This was just an example; there are different training goals that require specific training sessions and programmes. Here some quick suggestions for everybody:

  1. Set the goal.
  2. Make your efforts measurable.
  3. Keep a diary of your training.
  4. Understand the concept of “accommodation”.
  5. If you notice that your performance is getting worse or you are in a plateau, probably, you need to rest or change your programme.

Set the goal: training with a purpose, with a goal in mind is more effective than just going out to perform some jogging. Obviously, having a goal means to make efforts measurable. There are many ways to do it and they all depend on your goal. It is not difficult. You want to lose weight? A scale is a good tool for you. I suggest getting one of those that measure factors like BMI, Body fat percentage, etc., because with training you tend to increase your muscle mass (which is heavier). If you do not want to spend money for a scale, just use a meter tape to measure your tummy girth. That is an old and very reliable measurement of your progressions.

Then… write it down! People think that I am a little weirdo, because I go around the gym with a little paper notebook and a pen. Yes, I am only partially technological, but today you are in the golden age of technology that helps you to keep a diary without losing time to do it. There are apps for strength training, for cardio training, for high intensity training (HIIT), smartwatch for runners, walkers, hikers, even golfers! If you are doing your training honestly and correctly you will notice that it will start to be easier for you to perform the same tasks. That is called “accommodation” and it is both positive and negative. Positive, because it means that you are improving; negative, because the response of the organism to the same stimulus will be less and less and your improvement will probably cease soon.

How to avoid it? You should plan variations in your training; simplifying, that means, for example, increasing your pace if you are a runner, or the load if you lift weights, or even change the type of the exercise that you are doing. At a certain point, you could notice that you are stuck in a plateau and you can’t improve anymore even if you try to increase the difficulty of your training. In this case, the reason could be that you are doing too much. Try to increase the time between sessions, instead, (two days, then three days… even a week or more) and you will see that you will be able to make your programme harder and restart improving. Again, I am not telling you that you can improve running in the park twice a month, but at a certain level of training you will feel the need to rest more between sessions.

What is the limit? Very rarely we can set a limit for a person. We know that it exists, but I have not found mine, yet. What I know is that it is possible to design the best work-out for everyone considering your needs, your passion and your goals.

This is just an article to stimulate you to think about your current situation. In the next one, here on J&P, I will talk about a very controversial topic: What is the best type of exercise? See you soon!


Mr Andrea Ronca

MCSP Senior Physiotherapist

Client Feedback

Finding the right physiotherapist for you is critical to help aid your recovery. Here at J & P we pride ourselves on only employing the best of the best and love hearing feedback from our customers (below).

I have today completed a course of physio at your Hoylake office following an injury to my right knee in March of this year. My therapist was Harry. I find that in general, people are normally quick to complain and slow to give thanks.

I was referred by my G.P. to J & P’s for treatment. During my course of treatment I always found the reception staff friendly, competent and always willing to explain anything I did not immediately understand. The booking system was clear and easy to understand. Bookings were confirmed by e-mail and this was re-enforced with a further e-mail the day prior to any appointment.

Harry my Physio took time to take full history of my injury, undertook an initial full physical examination, instructing me in exercises I should undertake at home between further appointments. I found him on each and every consultation, patient, knowledgeable and extremely competent in his craft and he constantly encouraged me to continue with my exercises.

Thanks to this partnership between your reception staff, Harry and I think my own efforts I believe I have achieved the recovery I had hoped for.

Please accept my thanks to J & P’s and be sure to pass this on to all your staff at the Hoylake J & P’s staff.

Golfer’s Elbow

Golfer’s Elbow

What is it?

With The Open Championship just finished now would be the best time to talk about an injury named because of how common it is with those that play Golf, “golfer’s elbow”.

Golfer’s elbow is characterised by pain on the inside of the elbow joint, this generally worsens through movements such as gripping, pushing, pulling and, of course, golf swings. Essentially golfer’s elbow is caused overuse of a group of muscles of the forearm called the “flexors”. These muscles all converge to form a tendon called the “common flexor tendon of the forearm”. In golfer’s it is this tendon which degenerates which causes pain on the inside of the elbow and decreased muscle strength of the attached muscles. It was previously thought that the tendon itself would become inflamed, however, this has since been disproven and therefore the term “tendinitis” is now been replaced by the term “tendinosis”.

How can joints and points help?

For all injuries Joints and Points can offer a high-quality physiotherapy to identify, diagnose and treat problems such as golfer’s elbow.  Your therapist will first question you on the injury (time of onset, pain levels, pain location etc) and will then apply different tests to rule in or out suspected pathologies.

What might treatment involve?

In physiotherapy treatment is always heavily reliant on the individual, for example golfer’s elbow is very prevalent among office workers who use a keyboard and a mouse all day, the rehabilitation programme will be different for this person than for a high-level golfer. In most cases treatment will involve manual therapy such as deep friction massage over the common flexor tendon, massage of the flexor muscles and even treatment of the neck if neck pathology is involved with the injury. Then, the therapist will give exercises which are designed to load the tendon which then has the effect of strengthening it, the most common exercise type prescribed for this injury is called “eccentric exercise. 

Customer Feedback




Here at J & P we regularly keep in touch with our customers after treatment to ensure they are given the best possible aftercare.

Its great to hear such positive feedback regarding our staff! Well done team!

” I found the situation that led me to contact Joints and Points was difficult for me personally for a variety of reasons. Harry was particularly understanding and his professionalism was something that gave me great confidence that I would be able to get through my shoulder problem and recover in a timely way. I started to make progress after my first visit and at each appointment throughout my treatment I knew exactly what to expect and how to help myself to improve.”

Lateral Ankle Sprain

Lateral Ankle Sprain

What is it?

With Wimbledon starting now is time to talk about the most common Tennis injury, the lateral ankle sprain. Tennis involves lots of lateral (side to side) and rotational movements which can significantly stress the players muscular system around the ankle joint. When tired, these muscles do not work as effectively and this can result in an ankle sprain. The mechanism is simple and normally is result of a sideways movement, the person’s foot points inwards with their weight on the outside of the foot, this lengthens the structures on the outside of the ankle and can cause them to tear if enough force is involved. This mechanism is called an “inversion injury”

Generally, the structures injured are a bundle of ligaments around the outside of the ankle called the “lateral ligament complex”, normally there are multiple ligaments involved. Quite commonly the “peroneal” muscles (muscles of the outside of the lower leg) also get strained during an injury like this.

It is imperative to have ankle sprains assessed quickly buy a clinician to ensure no serious has been done such as an ankle fracture or a damage to the cartilage.

How can joints and points help?

For this injury Joints and Points can offer a high a quality physiotherapy service to assess and treat musculoskeletal injuries, including ankle sprains. To correctly treat an ankle sprain it is imperative that a correct diagnosis of the issue is made, one of our clinicians will use a battery of tests to determine structures involved and the extent of the damage.

What might treatment involve?

In physiotherapy treatment is always heavily reliant on the individual, for example, a recreational Tennis player playing once per week would need a different rehabilitation protocol then a more serious competitor. Generally speaking most programmes will include manual therapy (massage, mobilisation, manipulation, ultrasound etc) and an exercise programme to increase the strength of the muscles around the ankle to aid healing and prevent re-injury of the area. Interestingly, some research has shown that after an ankle sprain there is a significant decrease in other, further away musculature like the glutes. In some cases, your clinician may feel the need to exercise other muscles along the “kinetic chain”.

10 Stress Buster Tips

If you’re stressed, within your work place or by personal circumstances, the most important thing to do is to stop and take a step back, write down all the things that you feel are causing you to be stressed.

Ask yourself a question, Can I change my situation or is it out of my control? If you are able to change the situation then work on changing it. If you are unable to change the situation and it is out of your control then simply but it down and let it go.

If stress is having a negative effect on your mood and you are feeling low, talk to someone who will listen to you and give you support. Making connections with family and friends can help you to gain a better perspective on the stressful situation.

Try to be active by going for walks, swimming or sort of activity that will help you reduce the effects of the stress hormone. This will help to clear your thought process.

Take back control of your life, the art of control is very empowering and will allow you to revaluate your life and start the process of making small positive changes each day.

Self-Care is important, how some me time allow time for you, by investing time for yourself to do things just for you will help you to unplug from stressful situation. You are the most important person to you so set time aside for you.

Be aware of unhealthy habits that might be adding to your stress and how you manage stress. Make a list of things that you feel may be adding to the way you feel. Then work on reducing the list in a healthy way, (one at a time).

Think of a time in your life when you did not feel the effects of damaging stress. Try and remember how you managed stressful situations. Try to reconnect back to you the person who was able to better manage stress.

Sleep is the most important thing you can do to help you manage stress. Develop a healthy sleep hygiene routine by ensuring that you bedroom is cool and dark. Never go to bed to sleep go to bed to relax, this can be supported by soft relaxing music or taking a nice relaxing bath before you go to bed.  Spend 15 minutes each night before you get into bed free writing your thoughts in a note book. This will help you to empty the mind chatter allowing you to let go of stressful thoughts.

Prioritising your life will help you to identify what is important to you. Think of how you would like to live your life and try to move towards your dreams.

Pay attention to the use of negative language as negative language will become part of your narrative in life. This may contribute to the way you manage stress. Think positive and be optimistic in the way you approach problems in work and in your personal life. This will enable you to let go of the emotional content and stay healthy.

Sometimes we may need to accept the things we cannot change and change the things we can change, this is how we develop our resilience and flexibility to life’s adversities