People, We’ve Got to Stop Icing. We Were Wrong, Sooo Wrong.
Ready to slay a sacred cow?
Here goes. You should stop icing. We were wrong. I know. I’ve even been guilty of advocated for short icing stints on this blog. I was wrong. For the past year, I’ve been engaged in a personal moral debate about icing that in retrospect, seems silly if not out right obvious. We should not ice. For the last year, I’ve advocated for no icing with every athlete with whom I’ve helped either post-surgery or post-injury. The outcomes have been nothing short of stunning. Even way back in Episode 204, “Donnie Thompson, Strongest Powerlifter Ever, Cares About Your Swelling,” (15 months ago) we started shifting our management of swelling chiefly to compression. And that was before I met Gary Reinl of Marc Pro. Every athlete worth his or her salt knows of the old RICE acronym. And dammit if I wasn’t already hearing and experimenting with reduced icing protocols for the last few years (remember numb and done?). My problem with NOT icing, I told myself was that I didn’t have other good tools on hand to minimize the pain of swelling (which is the real athlete problem eh?). As it turned out, the solutions presented themselves (excellent compression apparel, Dick Hartzell’s compression protocol, and the Marc Pro) at the same time that common sense matched up with my own clinical experience and test/retest ethic. Maybe it was because I finally felt like I had other mechanisms with which to deal with the swelling, that I could resolve the dissonance I had around this outdated modality. Don’t get me wrong, if you need to make something numb, ice is great. As Mr. Reinl points out, “Yes, (making something numb is good) if the short-term goal is pain control and the prevention of the body’s normal cellular and vascular response to injury.”
Let me quote Dr. Nick DiNubile, Editor in Chief of The Physician And Sports Medicine Journal (physsportsmed.com) “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”
Well what does the research and literature say?
“When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ‘dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ‘in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.” The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986
Or how about this comprehensive literature review from the Journal of Emergency Medicine?
“Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?” JEM, 2008; Feb. 25; 65–68
Abstract: Aims: The use of ice or cryotherapy in the management of acute soft tissue injuries is widely accepted and widely practiced. This review was conducted to examine the medical literature to investigate if there is evidence to support an improvement in clinical outcome following the use of ice or cryotherapy. Methods: A comprehensive literature search was performed and all human and animal trials or systematic reviews pertaining to soft tissue trauma, ice or cryotherapy were assessed. The clinically relevant outcome measures were: (1) a reduction in pain; (2) a reduction in swelling or edema; (3) improved function; or (4) return to participation in normal activity. Results: Six relevant trials in humans were identified, four of which lacked randomization and blinding. There were two wellconducted randomized controlled trials, one showing supportive evidence for the use of a cooling gel and the other not reaching statistical significance. Four animal studies showed that modest cooling reduced edema but excessive or prolonged cooling is damaging. There were two systematic reviews, one of which was inconclusive and the other suggested that ice may hasten return to participation.” Conclusion: There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.
Look, I know you have iced your body about a billion times. I also know that it’s hard to resolve the dissonance about potentially retarding your own healing response by doing so. I personally had a difficult time slaying this icing error beast until I was confronted directly with the physiology, and my own clinical experience working with surgeries, injuries, and even rhabdo–all without ice. It’s hard to fight the drag of orthodoxy. Why do we do what we do? Because we always have? We can do better. Our goal needs to be to improve adaptation by improving circulation, clearing congestion, and facilitating healing. Pretty much everyone I know has stopped taking NSAIDS for the same reasoning that we should stop icing. Let’s kick the ice habit too.
Here is the interview with the inflammation slayer, Gary Reinl, from the recent Crossfit Games. Be prepared to have your mind blown.
So let’s come up with our own new acronym and replace the old, broken RICE model.
Here is the MWod take: MCE
Move safely when you can, what you can. Compress lymphatics and soft tissues (use bands, muscle contraction, clothing, normatec, etc.) Elevate when you can. MCE.
Rest really doesn’t make sense (Don’t flex your broken bone, duh. But do figure out a way to evacuate the swelling left over from the inflammatory cycle.) Ice? No thanks.
Ps. My success and experience with the Marc Pro technology was so profound that we talked the company into donating a unit to our wounded warrior brothers and sisters for every six units our community purchased. If you are interested in this program, please email Troy Willis, email@example.com. During your check out at Marc Pro, use the code “Kstar” and you will receive a small discount and have your purchase counted toward our wounded warriors.
pss. Gary, thanks.