We have recently become interested, well more like fascinated with the notion that icing is bad for your injury treatment and recovery. We’d begun looking into the topic and have done a few write ups on that topic on this site. After we posted our story on this subject “Hold the Ice…Seriously” we saw that there were some discussions and resistance to the idea that ice isn’t a good option for soft tissue treatment. We posted a video with mobility and performance expert Dr. Kelly Starrett and Gary Reinl which breaks it down, but even then some of the chatter was still looking at ice being good for treatment.
So we finally said lets go to the source and ask Dr. Kelly Starrett himself for the information.
You may say why should we listen to this guy? Well Kelly Starrett is a doctor of Physical Therapy, who runs his own practice. He’s an owner and trainer of San Francisco Crossfit (one of the first Crossfit affiliates), he’s an author of four books (best sellers), he’s appeared on numerous programs like 60 Minutes Sports on Showtime, the Joe Rogan Podcast, the Barbell Shrugged Podcast, Model Health Show Podcast, Strength Matters Podcast, and many others as well as a number of magazines. He’s also the founder of the Mobility WOD website. We think he may know a bit about the subject and help us understand this serious paradigm shift for us athletes of not using ice.
Dr. Starrett has worked with rugby professionals at Munster (in Ireland) and the Harlequins (out of the UK), as well as NFL teams like the Saints, as well as numerous athletes and military personnel.
So when we sat down to talk to Dr. Kelly Starrett this past week we asked him how can we get people to understand that icing is not helping their injuries or recovery?
Right off the bat Dr. Starrett acknowledge that this is a massive paradigm shift for people, because for most of us, icing an injury has been the protocol they’ve been given all our life; from coaches, doctors, trainers, etc.
“What’s the goal? What’s the issue?” said Dr. Starrett. If the issue is swelling he asked why we would want to stop the inflammation. Inflammation for a soft tissue injury is the body’s natural response. A better question Dr. Starrett says we need to ask is, are you wanting reduce pain vs. the swelling? Again the question Dr. Starrett poses is “What is the goal?”
Inflammation after an injury is the body’s way of trying to stabilize the injury. The swelling is the body trying to pump blood and nutrients to the injured area and also draw away the “bad blood”, etc. Ice slows down blood flow, slows down movement, and really preserves things. Dr. Starrett says “In Eastern and Chinese medicine they use ice for dead things, to preserve it”. We are not a corpse so do we need preservation? So does ice heal or preserve the swelling?
Dr. Starrett uses a great example to help with the paradigm shift. He says “if you are driving a car and want to stop it, you can turn the ignition off, and it will stop, but it will also lock up. You’ll only be able to stop the car by turning off the ignition a few times before something bad happens. It works at times but it’s not a good option”. So icing may numb/stop pain like turning the car off to stop it, but it’s not really a good option.
“There are only a few options to remove swelling, time, or if you want go faster you will have to use other options” says Starrett. Numbing (with ice) actually reduces circulation so good blood is not able to get to the injured area to begin the repair. “The numbing effect by the ice also cuts off the connection from the brain, and thus preventing the recovery or the brain’s ability to send hormones to help with the healing process” notes Starrett. Ice numbs as do drugs/medications. Starrett tells us that both ice and pain pills cut off pain but aren’t healing. Swelling is part of the healing process as we noted, the need is to then move the waste out. Dr. Starrett calls it “groceries in and garbage out” (with the new blood and nutrients getting to the injury, and the waste needing to flush/ moving out).
Dr. Starrett asked us a question. “When you ice does it get into the joints? No? Why do you ice for 20min, what is it that makes that the time line? Is it based on any scientific fact? How cool do you need to get the injured area? We don’t take the temperature of the area we are icing to see if it’s reached some desired temperature. Why? What is it all based on?”
Ponder those questions on icing!
Dr. Starrett says we seek to remove the swelling so to promote function. By that we mean we are getting the blood moving, we are getting motion and movement back and we are getting back to where we could move like before (function). There is only one way to flush that swelling out and that is through the Lymphatic System(the body’s system of tissues and organs that help the body remove waste, toxins, and other unwanted things from the body). That occurs with time or compression.
Now if you can get a Mark Pro that is a great way to get muscle contraction and compression to get the swelling moving through the Lymphatic System, but it’s a pricey tool. Using the Voodoo Floss is a quick and easy way to reduce swelling and to help flush out the waste. The Voodoo Floss is a thin, very stretchable rubber band that can be tied/wrapped around swelling and force the waste/toxin to start moving out through the lymphatic system. Dr. Starrett suggests that every trainer have one, and that every athlete keep on in their kit bag. It’s cheap and easy to use.
Dr. Starrett uses another example of swelling and treatment. He asked us to think of when you roll an ankle or some other soft tissue injury in a game. Starrett says “Think if you sprain your ankle in a game. Does it swell right away or slowly? Why can you still keep playing? Is it because the swelling is slow? Why its not being iced as you run around? Is it the movement? ….When injured movement is key!” The movement keeps the function. The movement keeps circulation and thus slows swelling, and gets the recovery process started.
What happens if it’s a bit more serious, or let’s say afterwards you now have swelling from a soft tissue injury? Starrett says it’s the same thing. Reduce (not prevent) the swelling not with ice but movement (if it doesn’t hurt too bad) and compression so you can get ahead on your recovery and be able to play sooner. Another example Starrett gives with benefits of reducing the swelling with active recovery (movement, massage, compression) is this, “Think of any injuries you’ve had with swelling. What do the doctors say when you go in then or a few days later? They usually say they can’t do much in terms of examining, operating or treating until the swelling goes down. So if you are active in trying to remove the swelling through active recovery vs ice (that slows it down), you can have a doctor examine the injury sooner and start any course faster (even allowing surgery to take place sooner). The faster all this happens the sooner you’ll be back to playing” share Starrett. So icing slows down the recovery by not reducing the swelling but maintaining it, but going with a more active approach such as compression, muscle movement, massage, etc. you can speed up the recovery and any other treatment you may need.
Starrett says that to get the paradigm shift people need to have good information and examples. He says “When you give people good information, the informed people can now make good decision. That’s what’s why sharing this information is important”.
We asked Dr. Starrett about rugby and since he’s located in the Bay Area if he’s worked with a lot of ruggers? He did say that he and his team are big fans of rugby, and while he’s worked with professional clubs overseas he really hasn’t worked with a lot of rugby players. He shared that some of the Olympic Club players have trained at his gym but not worked with him specific to rugby.
Starrett’s take on rugby is as follows: “Rugby is a collision sport! It also forces you to put your body into unusual positions. So it’s important to train your body and work on mobility and to take care of your body because of the level and amount of contact rugby players experience”.
We then spoke about things that can help rugby players. We asked of his 10min Squat Test. The 10 Min Squat Test is a great tool for front row players. It’s not using anything other than body weight, but is so focused on proper positioning of the various parts of the boys (same as in a scrum). The back has to be straight. The shoulders are back, the feet wide and straight, the knees in the right position, etc. Starrett said “That activates all the things you need in a scrum, glutes, back, quads, knees, and feet.” Check out videos online on the 10min Squat Test.
Dr. Starrett said in addition to the strength training we should also focus on mobility. He gave us another good example. He pointed out with the line-out throws the hooker should have a full range of motion. When they don’t they will likely have their elbows flaring out vs tight, which will result in a loss of power, which impacts the quality of the throw. “It becomes a performance issue. If you aren’t at your best then you hurt your own play and that of the team’s”.
We asked Dr. Starrett what young players could focus on and he suggested that younger players work to develop their full range of motion, which will help across different positions and focus but also reduce injuries.
We asked him if someone had just $50 and has the option of getting this book Becoming A Supple Leopard (2nd Edition), or getting a subscription to his site MobilityWOD.com which has videos and other mobility tips, which should they opt for. Without hesitation he suggested the book. He said the book is built for sport. The book is geared for athletes, trainers, coaches, etc. and that with the book users would be able to go back and go over it as many times as they need. The new edition of the book has 100 additional pages (500 pages of info) and features prescriptions, recipes, guidelines, sketches, and other tips to help athletes fix themselves. The book is meant to be a reference so they can keep going back says Starrett. “It’s not meant for them to become an expert from reading it once, but to use it as a resource on a regular bases. Remember enlightenment doesn’t come from a onetime experience”. Starrett feels everyone should have the ability to understand their body and how to fix it. That’s why he strongly suggests the book.
We want to thank Dr. Kelly Starrett for taking the time to share this information with us here at The Rugby Republic and with the ruggers. We hope you’ll find the information useful.
You can check out Dr. Starrett at his site www.mobilitywod.com and a lot of tips on YouTube. You can order the book at www.becomingasuppleleopard.com . Click on the photo of the Voodoo Floss to find out how to order those. You can also get updates by following him on Twitter-@MobilityWOD