Ice After Injury

For years when someone is injured or suffering DOMs you immediately hear ‘put some ice on it’,  it’s what many in the medical field have been preaching for decades. Ice is NOT helping the healing process from injury and in fact an overwhelming amount of research shows it does the opposite! Other than temporarily numbing the sensation of pain, ice delays healing and recovery.

In 1978 Harvard physician Dr. Gabe Mirkin coined the term RICE (Rest. Ice. Compression. Elevation.) as the recommended treatment for sports injuries in his landmark ‘The Sports Medicine Book.’1 Since this time, the medical community has religiously used this protocol for the treatment of all acute injuries. Now if you were to ask a medical doctor today why they recommend ice for the common ankle sprain or back ache, they’ll likely say it helps alleviate pain, reduce inflammation, and restricts swelling.

If everyone is using ice, What’s so wrong about it?

Ice does provides temporary pain relief. Put on an ice pack on an area of your body that is in pain and instantly you’re going to start feeling better. If you look at the scientific research out there on the use of ice (cryotherapy) a reduction in pain is the number one benefit

Just because the pain is decreased does not mean you’re fixing the injury. In fact, you’re actually doing more harm than good.Dr. Gabe Mirkin (the man who invented the R.I.C.E protocol) admitted in 2013 “Subsequent research shows that ice can actually delay recovery. Mild movement helps tissue to heal faster, and the application of cold suppresses the immune responses that start and hasten recovery. Icing does help suppress pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So, today, RICE is not the preferred treatment for an acute athletic injury.” 2

Inflammation & Swelling

We’ve always been told that inflammation and swelling are bad things that we need to stop as soon as possible. In fact, inflammation and swelling are normal responses to injury. Healing requires inflammation. It is an essential biological response following an injury. A lack of inflammation blunts the healing process and contributes to poor muscle regeneration! 3-7 This “blunting” of the healing process occurs when you use ice!  

While you think you’re helping the healing process by placing a bag of ice on your body, you’re actually delaying it from ever starting by preventing the body from doing what it wants and needs to do. 8

Swelling? Isn’t ice great for that?

Swelling itself isn’t a good or bad thing. It’s simply the end response of the inflammatory cycle. It’s what we do about it that makes all the difference.

Following injury the surrounding blood vessels dilate as part of the inflammatory response and the small capillaries surrounding the damaged tissue “open up” to allow white blood cells to arrive. This rush of white blood cells out of the capillaries also pulls additional fluid into the surrounding tissue (we call this accumulation “swelling”).

The additional fluid that now contains waste can’t leave the same way they came in (through the circulatory system). It has to be evacuated through lymphatic system. The lymphatic system is completely “passive.” When you contract your muscles, the lymphatic vessels deep inside your body are squeezed and the fluid within is forced it to move. 

Ice does not facilitate clearance of swelling through the passive lymphatic system. While resting and icing may feel good in the short term, you’re actually trapping debris around the injury and stunting the natural healing process from occurring.

The reason swelling accumulates around an injured area of your body is because we stop moving! It’s not because there is “excessive swelling” but rather because we aren’t doing anything to facilitate lymphatic drainage to pull it away. Instead of trying to block swelling from accumulating in the first place by icing (which clearly has detrimental healing effects), we need to be proactive and work on improving the evacuation of the fluid and waste that does accumulate.

Exercises performed in a relatively pain-free manner not only accelerate swelling removal through muscle contraction but also optimises the healing process without causing additional damage! Now it may seem counterintuitive that we want to move an injury but that’s actually the best thing to do! Loading damaged tissue with proper exercises as soon as possible following injury actually accelerates healing of muscle and bone. 9

Directly after injury, the goal with movement is to facilitate healing without causing additional damage. Exercise too intensely and place too much load on the body and you’re only going to make things worse.

Ultimately, icing is not as good as we all thought and rather the best form of treatment is moving and loading the injured area through rehabilitation exercise.

References

1. Mirkin G, Hoffman M. The Sports Medicine Book. 1978. Little Brown & Co

2. Reinl G. Iced! The illusionary treatment option. 2nd Edition. Gary Reinl. 2014.

3. Lu H, Huang D, Saederup N, et al. Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. FASEB J. 2011;25(1):358-69.

4. Summan M, Warren GL, Mercer RR, Chapman R, et al. Macrophages and skeletal muscle regeneration: a clodronate-containing liposome depletion study. Am J Physiol Regul Integr Comp Physiol. 2006;290(6):R1488-95

5. Pelosi L, Giacinti C, Nardis C, Borsellino G, et al. (2007) Local expression of IGF-1 accelerates muscle regeneration by rapidly modulating inflammatory cytokines and chemokines. FASEB J. 21, 1393–1402

6. Singh DP, Lonbani ZB, Woodruff MA, Parker JP, et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol. 2017;8:93.

7. Takagi R., Fujita N., Arakawa T., Kawada S., Ishii N., Miki A. (2011). Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats. J. Appl. Physiol. 110, 382–388.

8. Tiidus PM. Alternative traetments for muscle injury: massage, cryotherapy, and hyperbaric oxygen. Current reviews in musculoskeletal medicine. 2015;8(2):162-7

9. Buckwalter JA, Grodzinsky AJ. Loading of healing bone, fibrous tissue, and muscle: implications for orthopaedic practice. J Am Acad Orthop Surg. 1999;7(5):291-9.

The source material and for more more in-depth information look at Squat University and by Dr. Aaron Horschig.