Thought-tober: Icing

The health world is full of whoops. As in “whoops, that recommendation we were making all that time may not have been right after all…”

One of the latest ones popping up the last few years has been the use of ice to treat/help heal injuries. The old standard of care, RICE (Rest, Ice, Compression, Elevation), has been the way to do it for 30+ years. It relieves pain and brings swelling down, a supposed good thing. Unfortunately, this just might be the opposite of what we need to do…

Rethinking Icing

As with almost everything in health, the conclusions we came to in the Age of Health Enlightenment (~1960s to 1980s) are crumbling left and right. Icing injuries is another realm that’s being rethought. It’s not uncommon to have people challenge the conventional wisdom and this is no exception. As with all of these health assumptions, there have been people challenging them since the beginning. However, once a health truth settles in it’s very hard to dislodge it. That being said, let’s get back to the ice situation.

Quite a few people have expressed their belief that the insistence on using ice to treat injuries has been misguided. The basic point of the criticism is that the body needs inflammation to start the healing process and needs blood and nutrients to flow through an injured area to bring in repair materials and remove waste products for optimal recovery. Ice slows or stops this entire process down, delaying healing. The more and longer you ice the longer it takes to work through the healing process. As with many of our health truths, we are finding that as a general rule, when we work against the body’s natural processes the more trouble we create. When we use the body’s adaptive responses as a guide, then support the body, we typically get much better results.

For those still feeling ice is the way to go, here’s a quote from Dr. Gabe Mirkin, the creator of the RICE treatment guidelines:

Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.

In his article, Why Ice Delays Healing, Dr. Mirkin outlines why he has changed his approach. Here is my synopsis of that article:

Healing Requires Inflammation
Applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.
Ice Keeps Healing Cells from Entering Injured Tissue
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation.
Anything That Reduces Inflammation Also Delays Healing
Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:
• cortisone-type drugs,
• almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
• immune suppressants that are often used to treat arthritis, cancer or psoriasis,
• applying cold packs or ice, and
• anything else that blocks the immune response to injury.
Ice Also Reduces Strength, Speed, Endurance and Coordination
The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination.
If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain.

Here’s a nice article and video on this concept, featuring Gary Reinl and Kelly Starett, two of the leading people in rehab & performance. I’ve met with Gary and discussed this and really appreciate his perspective.

The bottom line: even the creator of RICE has changed his recommendation, don’t be afraid to rethink how you treat injuries. I rarely ice and if I do it’s short term at the immediate onset. I will use compression and heat from there. Ultimately, I try to work with the body, not against it.

Thanks for reading, have a great day!

P.S. Two more articles on this…
Quick: To Ice or Not To Ice?
Detailed: RICE Therapy