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Should we be icing our injuries?
Icing is a modality that has been used for both minor and major injuries. When someone hurts a joint in an athletic event, the first thing someone normally says is “put some ice on it”. So, my question is why? You’ll be surprised to hear is that there is a lack of evidence in the effectiveness of icing. Physiologically, we can even make sound reasoning that icing can actually hinder the tissue rebuilding process.
In 1978 the term “RICE” was coined by Gabe Mirkin, MD. Rest, Ice, Compression, and Elevation. It is common to see athletic training rooms and physical therapy clinics across the country give this recommendation to injured athletes. It makes sense right? To decrease swelling, we need to rest in order to allow the tissue to heal. We need to ice it because that decreases the blood flow to the area, so that must could stop the swelling production along with decreasing the metabolic process of the damaged tissue to hinder it from further damage. We need to use compression because it has been shown to work for treating edema patients for many years. It creates a pressure gradient to allow swelling to flow from a concentration of high pressure to an area of low pressure. And lastly, we need to elevate the injured area. The excess swelling may be decreased when we use gravity to pull it back down to the center of the body.
What most people do not know is that Gabe Mirkin, MD denounced “RICE” as the best acute injury treatment in 2014. While compression and elevation are still very valuable, the use of rest and ice need a little bit more discussion.
As research improved, we learned more about the process of healing. What we know is that inflammation is the first part of the healing process. If we don’t have the inflammation process, the joint misses vital metabolites needed for the healing process. The body is extremely smart. It should know how much inflammation an injured area needs to heal. When we ice an acute injury, we slow down or pause the process of inflammation. Once the ice is removed, the tissue heats back up and the inflammation process begins. We have all experienced this. We sprain our ankle playing hoops, we ice it, but by the time we get home our ankle is the size of a softball. Does icing really reduce the amount of swelling accumulation? The lack of research answers with: “We don’t know”. Many rehabilitation professionals now believe that the process of icing is just slowing down the healing process. If we can get the inflammatory response to start the healing process, we may be able to recover sooner.
Now what about swelling that has gone on for a few days or even weeks? Before making any more statements I want to ensure the importance of seeing a primary care provider if you do have or obtain an injury that lasts longer than several days or continues to get worse, or if its something of immediate concern. If you have a severe injury, it is better to get it looked at/cleared sooner than later. After making sure that the injured tissue is healing, we need to follow some simple protocols to improve the healing ability of the tissue and reduce the amount of swelling.
We know that icing CANNOT reduce the amount of swelling that is already in the joint. There is no mechanism that makes logical sense for how it could reduce swelling. Excess swelling is carried away by lymph channels, not through blood circulation. When we ice the injured tissue, it closes off the lymph channels, making it impossible for the excess swelling to go anywhere. Some rehabilitation professionals even claim that the channels can back flow causes the excess swelling to get even worse. Instead of icing, movement is the most efficient way to clear excess swelling. Movement opens up the lymph channels for the uptake of excessive swelling. Instead of icing injuries, move through a pain-free range of motion as often as you can. If you’re wearing a cast or brace, limiting your motion at that area, move the muscles around that area. Any movement is better than no movement. This is why the muscle stimulator units (Marco PRO, Compex) are so popular. They are shown to improve the recovery of damaged tissue.
With that, there are certain situations where icing is beneficial. Icing is great at reducing the amount of pain in a given area. With the pandemic of pain killers in America, ice is a safe alternative. If you are in serious pain, put some ice of the area. It will reduce the speed at which nerve impulses travel relaying information about the pain. Another time ice is beneficial is if you lose a body part. This is in fact where icing was first introduced. If you lose a finger you want to ice the finger and your hand to preserve the tissue in hopes to keep it from decomposing.
As you can see, there are few areas in where icing is PROVEN to help recovery of a specific injury. If you have a minor ache or injury, you can do other things to help yourself heal. Now that we know “RICE” might not be the best modality for rehabilitating injuries, let’s go over what we can do instead.
Move through a pain free range of motion often. Elevate an injury above the heart as high as tolerable. Compress the tissue around the joint or injury site from distal to proximal. Smash or massage the surrounding tissue to work out the connective tissue and open the lymph channels.
I hope this helps! This is a very controversial topic in strength and conditioning and rehabilitation. Icing feels good! It may directly work as a placebo or even as a calming mechanism, but physiologically it doesn’t seem to add up. Until more research is done, blindly recommending icing for an injury may cause more harm than good.
If you are interested in learning more about Dr. Mirkin’s new position on icing check out his website: http://www.drmirkin.com/fitness/why-ice-delays-recovery.html
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