By: Luis Garcia ATC/LAT,CSCS
For decades there has been this idea that ICE is the all knowing solution to all of our acute injuries. Ankle sprain? ice. Finger hurts? Ice. Swollen knee? Ice. Failed math test? Ice. What if I told you that this concept that has been floating around for decades is WRONG.
INTRO
Ice is not what you think it is. Ice does not help the healing process from injury. As a matter of fact OVERWHELMING amounts of evidence show that that is does the complete opposite. Ice temporarily numbs the effects of pain, pain is a symptom and getting rid of pain has zero relation with speeding up the healing process, it actually slows it down. (Link Below)
THE HISTORY OF ICE
The term "RICE" (Rest, ice, compression, and elevation) was coined by Harvard physician Dr. Gabe Mirkin in 1978, who later came out and reversed what he originally said. Stating that ice can actually DELAY recovery. From a young age we are taught that anytime something hurts, put ice on it. Wrap it up with an ace bandage 3x a day, this will make it better. We do this because as kids we don't know any better, and after years of hearing the same thing we assume it to be true. Being told things like ice gets rid of harmful inflammation and swelling.
Now don't get me wrong, if you turn on the tv or even put in a simple google search you'll find thousands of professional athletes, including greats like Michael Jordan, wrapped up with ice bags from head to toe. Thats enough to make anyone want use ice one a daily basis. As a collegiate athlete I commonly used ice and took ice baths after intense training sessions, practices, and games. It was part of the culture of being a basketball player, you ice after practice and games. In my head I was kick starting the recovery process, or at least thats how it was sold to me.
Ice is seen in just about every rehabilitation profession. From physical therapist to athletic trainers and even chiropractors. The first profession to implement this technique was the medical field. Back in the early 1900s, doctors used ice to block pain, decrease infections, and stop tissue death during amputations. This is because ice slows down cellular metabolism allowing a doctor to keep as much tissue alive during an amputation. Originally this was the intended goal for ice, decrease complications in the operating room.(Article Below)
ISN'T EVERYBODY DOING IT?
You can not deny that ice has an instant and temporary relief on pain. If you've ever used ice you can attest for the fact that your pain sensation decreases and begins to "numb". If you look at scientific research the number one benefit of cryotherapy is reduction of pain. This is the problem though, just because pain is reduced does not mean you are fixing the injury, You're actually doing more harm than good.
in 2013 Dr Gabe Mirkin came out and said this statement “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.” (article below)
ICE and how it effects your body
Inflammation and swelling are normal responses to injury done by our bodies. If you ask any medical professional the 3 phases of healing they will tell you inflammation, repair, and remodel. INFLAMMATION is the first stage of the healing process, no matter the location or the severity of the injury occurring in your body, inflammation is the first step. If this is a normal response from the body, why are we trying to block it?
So lets say you sprained your ankle, White blood cells (inflammatory cells) rush to the site of pain to start the healing process. Here neutrophils and macrophages begin this first steps of the healing process, these cells then release an anabolic hormone called Insuline-like growth factor (IGF-1) to start the next process of healing, to repair muscle and regenerate.
Explained simply healing REQUIRES inflammation. Its not bad like we have been told our entire lives. A lack of inflammation can slow down the healing process and contribute to poor muscle regeneration, this happens when using ice. (Articles below)
Ice on an injury prevents the body from doing what it needs to do.
WHAT ABOUT SWELLING?
Swelling is the end response to the inflammatory cycle. Most doctors may tell you that EXCESSIVE swelling can lead to pain, decreased range of motion, and making recovery time longer. This statement is true. If you allow swelling to stay within a joint for a prolonged period of time, it can have negative effects.
The initial rushing of white blood cells can bring with it fluid that is retained in the surrounding capillaries and tissues (swelling). Swelling is there for a reason though, inside your swelling you have the byproducts of all the damaged tissues and waste from the healing process. swelling myst be evacuated through a system called the lymphatic system. The lymphatic system is a tube like system that runs through your entire body (just like your arteries and veins). Unlike arteries your lymphatic system is passive and doesn't have an engine to help push swelling through it. This means the only was to use your lymphatic system is through "mechanical pressure" which can only come from your muscles. When you contract your muscles the deep lymphatic vessels are squeezed and the fluid within them is forced to move.
Ice does NOT help to remove swelling through the lymphatic system. So when you ice swelling you are actually trapping all that damaged tissue and waste in the area, further stunting the natural healing process. This is why movement is KEY.
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. We need to work on evacuating swelling not preventing it.
In 2005 researchers conducted a meta-analysis (meaning a study of all available studies) on the use of cryotherapy directly after ACL reconstruction surgery. They concluded that the only benefit was in lowering pain. Icing did not improve how much the person could move their knee or lead to any decreases in swelling. (article below)
Performing pain-free exercise following injury has countless benefits. Muscle contraction enhance the inflammation process by improving macrophage function and allowing these essential white blood cells to remove damaged cells. It also boosts muscle repair and regeneration and limits scar tissue formation through activation of stem cells. (Article below)
Right after injury the goal with movement is to help the healing process with no additional damage. This is why we shouldn't be doing sprints after an ACL surgery, because we will be causing more damage. Pain free movement is the key here. One of the safest contractions is the isometric contraction. A contraction that involves no joint movement or change in length in a muscle. Straighten your leg out ad contract your quad for 10s, you are performing an isometric quad contraction, Something safe and warranted for an ACL Post surgery. Something that can increase quad strength and assist in evacuating swelling!
CONCLUSION
So it turns out then when you were a little kid and your dad or coach told you to "walk it off" they were right! After evaluating all the scientific literature and research there is strong clinical evidence that we should not advocate cryotherapy. Icing isn't as good as we all thought and the best form of treatment is moving and loading tissues through proper rehabilitation exercises. STOP WITH THE DAMN ICE.
For rehabilitation programs head to "shop" at the top of the page.
Kommentare