Icing: It's Not Cool
“Put ice on it!” has become the standard recommendation for just about any injury. Not only do most coaches and trainers believe that ice is the most appropriate treatment for everything from black eyes to torn ACLs, but many also recommend taking uncomfortable “ice baths” to help recover from especially hard workouts. There’s only one problem: Icing an injury doesn’t work. In fact, it can even interfere with the healing process.
Such is the basis of Gary Reinl’s self-published book, Iced! The Illusionary Treatment Option. Reinl contends that inflammation is a critical part of the healing process, and that “there is no peer-reviewed, indisputable published evidence (indexed on PubMed) that the use of ice improves the recovery process. None!” In fact, Reinl says, icing an injured area only delays the process. Says Reinl, “Think of it this way: you want fluid to get there – because that means that the inflammatory response is doing its job – but you also want it to leave as quickly as possible.”
In contrast to inflammation, swelling can be regarded as the accumulation of waste at the completion of the inflammatory cycle, says Reinl. The swelling process is regulated by the lymphatic system, which relies on muscle activation to function properly. Reinl believes that ice limits muscle activation and thus interferes with the function of the lymphatic system. “Essentially, the ‘cold’ causes the one-way valves to open in the wrong direction, which creates more swelling,” says Reinl.
Reinl’s observations concerning the effects of ice on swelling are supported by a peer-reviewed article published in Sports Medicine in 1986. The authors of this paper explained that when ice is applied to a body part, lymphatic permeability is increased, such that fluid flows in the wrong direction, thus “…increasing the amount of local swelling and pressure and potentially contributing to greater pain.”
As for reducing muscle soreness, ice doesn’t appear to accelerate the recovery process – a realization that will come as a surprise to thousands of athletes (especially gymnasts and football players) who have been forced to endure painful ice baths. According to a paper published in the May 2013 Journal of Strength and Conditioning Research, the authors concluded, “These data suggest cooling…appears to not improve but rather delay recovery from eccentric exercise-induced muscle damage.”
As for other methods that are used to deal with chronic swelling, specifically nonsteroidal anti-inflammatory drugs (NSAIDs), consider a report published in 1999 in The New England Journal of Medicine. The report extrapolated that the number of deaths per year from NSAIDs included an estimated 16,500 deaths just from the gastrointestinal side effects of NSAIDs alone. There’s more.
The FDA reported that in the first three months of 2008, there were over 2,700 deaths from NSAIDs. As if those numbers are not enough to scare you, according to a 2009 report published in the Annals of Medicine, the risk of developing complications (such as liver problems, stomach upset, blood disorders and vision problems) from taking anti-inflammatory drugs “is present from the first dose.”
Instead, to accelerate the healing process, Reinl believes that the best method is active recovery, or loading, which will “…cause enough pain-free stress to sufficiently activate the involved muscles for the desired period of time, but not enough stress to cause fatigue.” Examples of such methods include stationary bikes, upper body ergometers, vibration plates, weighted medicine balls, and free weights. Reinl also endorses the use of what he calls “powered-muscle stimulators.” He says such technology can “…make the recovery process easier (sometimes much easier), requires much less effort (e.g., essentially none), is often more comfortable, and is faster in many instances.”
Although not mentioned in Reinl’s book, another promising way to deal with chronic swelling and to accelerate healing is Frequency Specific Microcurrent (FSM). Developed in 1995 by Dr. Carolyn McMakin, an osteopath in Canada, FSM uses a specially calibrated machine to apply specific frequencies of electrical current matched to a specific injury and tissue. For example, after ACL surgery it can take several weeks for the swelling to decrease so that rehabilitation can begin; however, if FSM is applied within a few hours after surgery, often swelling can decrease to a level where rehabilitation can begin within 2-3 days after surgery.
It’s time for coaches to consider alternatives in treating swelling. Using NSAIDS is risky on many levels, and icing often does more harm than good. Considering the preponderance of evidence against using ice, perhaps it’s best to follow the advice from 2013’s megahit Frozen and “Let it go!”