Because I received backlash from some people for merely making mention of my anti-icing position before I wrote this post, I feel I must provide a cautionary disclosure for people who may not like or share my viewpoint…I am simply presenting the information as I see it; my personal reflections, thoughts, and opinions based on my own experience, patient results, and lots and lots of reading. It is my take on the current research and findings that are demonstrating that ice actually delays and inhibits the healing of injuries and I don’t expect everyone to agree with this evolutionary point of view. If you disagree with what I have to say and don’t like what you read, that is okay. You are entitled to your opinion just as I am entitled to mine; and if this information does not resonate with you, please disregard it and let it go. If you are still with me though, read on for some profound intellectual nourishment. Okay, now that you’ve been duly warned, here we go down the rabbit hole…
Ever since I started receiving acupuncture treatments about 20 years ago (in the 1990’s), my practitioners always told me not to ice injuries. The same message was impressed upon us all the way through grad school. But I had always wondered, ‘why?’ or rather ‘why not?’ I, like most people, had been taught that RICE (rest, ice, compression, elevation) was the gold standard in treating injuries and pain. The only explanation provided in acupuncture school was that Oriental medicine considers cold to be a cause of stagnation, which of course, made sense but I wasn’t able to intelligently integrate that wholly with the Western physiology of the body until now.
For the past month or two, since attending a continuing education seminar about injury and pain and hearing that even allopathic practitioners are now starting to veer away from recommending ice to their patients, I have been doing a lot of reading & research on icing and the current transition away from its use in treating injury & pain. Along the way, I have found an increased harmony between the anti-icing paradigm of Oriental medicine that is thousands of years old and the newly evolving Western attitude that agrees that ice is not the best answer when it comes to helping the healing process.
Classic Oriental medicine quote: “Where there is pain, there is no free flow; where there is free flow, there is no pain”.
Western quote: “There can be inflammation without healing; there cannot be healing without inflammation”.
Where am I going with all this, you might ask? Well, here it is in a nutshell – icing stops free flow and shuts down inflammation which in turn shuts off the healing process; all in all, RICE is not so nice after all.
There appears to be no scientific research studies proving that ice speeds healing or recovery. However, studies published in The Journal of Strength & Conditioning Research, The American Journal of Sports Medicine, The Journal of Emergency Medicine, and studies at the Cleveland Clinic, as well as information presented by experts such as Gary Reinl, a trainer of elite athletes with over 40 years of sports-medicine experience and author of ‘Iced – An Illusionary Treatment Option’; Dr. Leon Chaitow ND, DO, author of numerous books including ‘Fascial Dysfunction’; Dr. Kelly Starrett, a top physical therapist, CrossFit trainer, and author of ‘Becoming a Supple Leopard’; and even Dr. Gabe Mirkin, the physician who coined RICE back in the 70’s; are making it quite clear that rest and icing are not the best options for optimal healing.
Don’t get me wrong, ice still has its merits in certain situations, albeit a relatively small niche. For instance, if you sever a body part, by all means, yes, you want to decrease circulation and loss of blood as well as preserving the integrity of the body part so it doesn’t begin to decay and can be successfully reattached by a skilled surgeon. Or, if you are in the middle of the wilderness and significantly sprain your ankle, dunking it in the freezing cold stream for a few minutes so you can hobble the five miles back to your campsite or get back in cell service range so you can call for help is certainly preferable to freezing to death on the side of the mountain or getting eaten by a bear. But in normal daily life, ice is losing its momentum as the go-to treatment method for injuries. Really, it is a question of risk vs. benefit. If your life is at risk, by all means ice your injury…the reward of being alive far outweighs delayed healing. But if you are just trying to reduce pain and swelling by icing, consider the fact that you are simply delaying, not preventing the inevitable and necessary inflammatory response of the body and are only suppressing the body’s desire to get in there and start healing itself.
Long story short, inflammation is required for healing. The healing process is comprised of 3 stages: 1. Inflammation, 2. Repair, 3. Remodel. Therefore, inflammation must occur before either of the other two stages can commence. Ice does not know the difference between ‘good’ inflammation and ‘bad’ inflammation; so it shuts down the entire process, thwarting our body’s attempts to use its innate knowledge of what it needs to do. Unfortunately, we have gotten so stuck in the mindset that all inflammation is somehow bad, that we have become disconnected with the inherent wisdom of the body which, when confronted with an injury, immediately starts to bring ‘good’ inflammatory cells and chemicals to the injured area to begin the healing process (as well as other things like clotting factors to stop bleeding).
Yes, ice does temporarily reduce pain because it numbs the nerves and decreases nociceptive pain sensation. But ice also congests the tissues and shuts off the first step in the healing process – inflammation is absolutely necessary and some swelling is unavoidable for healing to take place and they will have to occur sooner or later.
Ice delays, but does not prevent, inflammation and swelling; it may in fact make it worse since the circulation of blood and lymph is drastically slowed for a period of time during and following the use of ice. This causes less fluid to leave the injured area, congesting the tissues and increasing pressure and swelling. The lymphatic system is truly a “transportation highway” for fluids in the body and correlates quite well with the San Jiao (Triple Warmer) in Oriental Medicine which was fondly referred to by one of my teachers as the “system of sluices and waterways”. It is how the body is able to move cells and components too large to be carried in the blood stream to the parts of the body responsible for their breakdown and elimination including the liver, kidneys, bowels, skin, and lungs. Unlike our blood circulation which is driven by the strong forceful pumping of the heart, the lymphatic circulation is passive, so ice brings the lymph flow to a sludgy crawl. The body then cannot effectively move the ‘dirty’ fluids and waste out of the injured area. Add to this rest or immobilization of the area, and the picture gets even worse since the lymph flow depends on the movement of muscles and tissues in the area to efficiently propel its flow. The buildup of excess fluid in the injured area causes increased pressure which creates additional pain. Gary Reinl makes a great analogy of how ice effects the lymphatic system with two tubes of toothpaste. If you put one tube in the freezer for a period of time, then get it back out and attempt to squeeze the two tubes, which one is easier to get the toothpaste out of? Pretty clear & makes sense, right?
So, what is the answer then? How should we be caring for our injuries? There appears to be a few basic methods that work to facilitate the best, most complete recovery from injury. First, there’s MCE, which stands for Movement/Mobility, Compression, Elevation. The second is METH – Movement, Elevation, Traction, & Heat. And lastly, ARITA – Active Recovery Is The Answer. Notice that the commonality between all three is to keep moving! Active recovery does not mean going out and performing the activity you got injured doing at 100% effort. But being sedentary and not moving at all doesn’t help recovery either. Active recovery is just that – keep moving, even if initially it is only very small movements of the injured area or the muscles surrounding the injured area. Move safely and in a manner that does not cause pain. But movement is key to helping the lymph system transport fluids through the site of injury and move waste products out. Massage the area gently if it feels okay and does not cause pain. Safe, gentle movement that does not create pain facilitates circulation of blood & lymph which speeds healing and recovery as well as preventing stiffness & atrophy. Decongesting the area through gentle movement and massage increases tissue perfusion and assists in decreasing swelling and pain. As far as compression, elevation, traction, and heat, I am not going to delve into those items here. Please consult a doctor and/or use your best judgement about what is most appropriate for your individual situation. Acupuncture and adjunct Oriental medicine modalities can also be very useful for acute and chronic injuries to help decongest the area and re-establish free flow.
To tie this all back in to the Oriental medicine side of things, Oriental medicine has believed for thousands of years that ice (cold) creates stagnation, and stagnation in the body creates pain, so icing has long been on their list of don’t-do’s. They have a strong connection with and history of watching and correlating what happens in nature to what happens in the human body. If you think about what happens when water gets so cold that it freezes, it stops moving, it is stagnant. In winter when it is cold, things naturally slow or cease their growth cycle, which could be viewed as what happens to the healing cycle when ice is used – it significantly slows down or stops altogether for a period of time. Hopefully, these correspondences to nature make it easier to visualize how the Oriental medicine anti-icing view very much parallels the newest information being observed and confirmed in the Western research studies.
So what happens if you have already been icing an injured or painful area? In my practice, I use not only acupuncture needles in local & distal areas to disperse stagnation and help move Qi, blood, and lymph through the area, but I use a liberal amount of moxibustion. Moxa is derived from the Artemisia vulgaris species of Mugwort plant. Its herbal properties include moving stagnation of Qi & blood, warming the channels & tissues, relieving pain, and nourishing areas of deficiency. It is used either directly on the skin or indirectly on top of the needles or in the form of a moxa roll. I also utilize cupping and gua sha as modalities for essentially pulling the cold to the surface so it can be dispelled thus freeing the flow in underlying tissues and structures.
Personally, I have not iced the last two or three significant injuries I have had – mostly because I hate being cold (hmmmm, perhaps I was actually just listening to my body’s innate wisdom); and in light of all this new information, I’m glad I did not give in to the peer pressure of the people who encouraged me to ice, ice, and ice some more. I’m sure that my healing was faster and more complete sans freezing my tissues.
Take this information, ponder it, digest it, do your own research, experiment with your own injuries, and draw your own conclusions. I encourage you to learn more, especially about the lymphatic system of the body – it is absolutely incredible and is only now getting its just due and recognition for its importance to our overall health and well-being in the mainstream medical community. I am including a short-ish, and by no means complete, list of references/links which includes websites and articles that are relatively short and easy to read and many of them contain links to further studies and articles for those more studiously inclined. I did not list the books I’ve read although there were a few mentioned way back in the beginning.
I know this has been a bit…no actually, quite long, so thank you for your perseverance if you read from beginning to end. I hope you found some of the information interesting and useful, and maybe even gleaned some new knowledge that may be helpful to you now or in the future.
References & Links:
Great short blogs about why medicine is moving away from icing:
Blog & video by Dr. Kelly Starrett: http://www.mobilitywod.com/propreview/people-weve-got-to-stop-icing-injuries-we-were-wrong-sooo-wrong-community-video/
http://garyreinl.com/ – multiple links to various articles, podcasts, etc. Gary Reinl is the author of the book ‘Iced – The Illusionary Treatment Option’
Study from Journal of Strength & Conditioning Research: http://journals.lww.com/nsca-jscr/Abstract/2013/05000/Topical_Cooling__Icing__Delays_Recovery_From.24.aspx
Dr. Gabe Mirkin’s website & blog: http://www.drmirkin.com/fitness/why-ice-delays-recovery.html
The New Injury Rehabilitation Paradigm (METH): http://theelitetrainer.com/index.cfm?t=Blog&pi=BLOG&blid=73
A good detailed overview of the lymphatic system: http://internalharmony.com/articles/14/Lymphatic-System-What-is-it.html
And last but not least, the wiki link for the lymphatic system: https://en.wikipedia.org/wiki/Lymphatic_system