We were recently listening to the Strength Matters Podcast (which we highly recommend if you want to learn about ways to train and improve performance), and the particular episode (episode 48) featured California based mobility expert Dr. Kelly Starrett from the Mobility WOD Project. Midway through the podcast the discussion turned to the old adage of using ice to treat injuries. On the podcast Dr Starrett began to shed light on this misnomer in the sport medicine world. He went as far as saying that the physician Dr. Gabe Mirkin, who wrote the RICE (Rest, Ice, Compression, and Elevation) protocol was now saying that icing an injury may not be an effective way to treat some injuries. In fact there seems to be some early research that is showing icing may actually slow down the healing process.
The following is some information we pulled from the Strength Matters Podcast with Dr Starrett. You can listen to the entire interview if you like to get the details.
Dr Starrett said on the podcast that ice is a great tool for preserving things. If you want to save something or keep it as is you freeze it. So by potentially icing something you are keeping that condition around longer, you are slowing down blood flow, and fluids from moving out (and flushing). Dr Starrett said ice is good for numbing for an acute injury (initial ankle sprain) or cryotherapy (so think of an ice bath to shock you system that drops your core temperature and your body resets). So ice can numb, but it doesn’t do much to heal.
Instead Starrett promoted “active recovery” saying active recovery is a more effective option than sitting around with bags of ice for days at a time.
Compression may be more effective way to help an injury heal than ice (which preserves or slows down the body’s national process to heal). So can pain-free motion/movement, massages, elevation, and slow movements that allow for the muscles to contract, says Starrett. Starrett notes that when we numb an injury with ice it takes away our ability to do work with muscle contraction.
Cooling of the tissue slows down some of the chemicals in that part of the body that come and repair or replace the danged tissue or blood, etc.
Ice is for pain, and for short period of time.
Dr. Starrett went on to say on the podcast that there is a lack of research on actual benefits of icing for tissue/muscle/joint injuries. Not that we didn’t believe the expert, but we wanted to check and see what was the general take on it and there seems to be more recent articles talking about the adverse effects of icing than promoting it.
As doctors and researchers work to learn more about how inflammation occurs, works and impacts performance and recovery the approach to treatment is changing.
One story pointed out that based on the popularity of icing and all the products you find at the drug stores that there must be a ton research, as well as university and professional studies on how ice is an effective or proven method for treatment of injuries, but to their surprise there wasn’t (Davis, 2015). Davis in his article (The Reason You Need to Stop Icing Your Running Injuries Right Now) points out that icing or more intensive icing treatment like Cryotherapy are used for things like surgery, sprains, but not for your regular muscle injuries, soreness, etc.
There has been one study cited where they tested icing for Achilles injuries vs physical therapy and found icing to have very limited benefits, but the physical therapy was more successful (J. Davis). This goes back to what Dr Starrett says about active recovery, contractions, etc.
Dr. Bahram Jam wrote in his article Paradigm Shifts: Use of Ice and NSADIS Post Acute Soft Tissue Injuries, “clinical trials on the efficacy of RICE (Rest, Ice, Compression, and Elevation) have supported the use of compression but have found no value in icing (other than the temporary numbing effect already mentioned) (Hubbard et al 2004).” This matches what mobility expert Dr. Starrett noted.
Dr. Jam clearly says in this article on icing that icing doesn’t work, and it is more likely to have a negative impact on your healing!
He cites similarity as Dr. Starrett did that the bodies evolutionary response to injury is natural inflammation (not the type caused from eating grains) and that if its worked for thousands of years or more, why do we think that its bad now and that ice would be the better option? He points out that until recent times, people didn’t have access to ice, so how did the human body cope all this time? He does note that in a lot of Eastern medicine like “Chinese and Ayurvedic Indian medicine, icing is believed to be counterproductive; perhaps they have it right and western medicine has it wrong.”
You may want to check out a story we did earlier on acupuncture for pain, recovery and treatment on this site.
In his article (Paradigm Shifts in use of Ice), Dr. Jam says it best so we quote it all
“Inflammation is an inevitable and an essential biological response following acute soft tissue injuries. It is a protective attempt by the body to remove the damaging stimuli and to begin the healing process. This allows more blood to arrive, and with it leukocytes and macrophages (white blood cells) to “clean up” the injured site. My only concern is that if we artificially “fiddle around” with the initial inflammatory phase of healing, are we not potentially influencing the final remodeling phase? It turns out that we may be negatively effecting tissue remodeling through our obsession to get rid of inflammation with icing and the use of non-steroidal anti-inflammatory drugs” (Jam 2014).
Both doctors Jam and Starrett say that the body’s mechanism for getting rid of inflammation and the likes is through “skeletal muscular contraction” and that using things like compression with elevation helps more than ice, which slows the “drainage” down. Dr. Jam actually cites Dr. Starrett in saying that icing causes the fluid build up and inflammation to stay (which actually causes the swelling you have to last longer).
In Dr. Jam’s article there is also a citation of a 2012 study (Bleakley et al 2012) that suggests that athletes may in fact be at a performance disadvantage if they return to their athletic activity immediately after 20 minutes of icing. Icing actually doesn’t help your recovery. It can actually cause muscle overload, which can lead to muscle fatigue and poor performance, or even more injuries. (Jam, 2014)
So if you have a serious injury, seek help from a medical professional, but if you have minor injuries and are thinking “I’ll just ice it after training”, the experts say don’t! Look to movement if it doesn’t hurt, easy muscle contraction, compression and elevation.
You can read the articles and listen to the podcasts yourselves. There is also more information via video from Kelly Starrett’s Mobility WOD project as well. Hope this can assist you with quicker recovery and improving your rugby performance. Ice for acute injuries as a pain blocker but not to heal or reduce swelling.
Thanks to the boys at Strength Matters Podcast for permission to use material from the podcast.
Davis, John “The Reason You Need to Stop Icing Your Running Injuries Right Now”. RunnersConnect.net 2015
Jam, Bahram. Paradigm Shifts: Use of Ice and NSAIDS Post Acute Soft Tissue Injuries (Part 1 of 2). Physicaltherapyweb.com 2014
Strength Matters Podcast (Episode 48). July 17, 2015