You Should Probably Stop Using Ice to Heal Injuries

For as long as I can remember, people have always told me to ice a musculoskeletal injury or sore muscle. I also typically see people use a hot/cold pack, take an ice bath or use the R.I.C.E. (Rest, Ice, Compress, Elevate) principal. You should probably stop icing injuries if you care about healing quickly and optimally. The truth is, it really depends on what you care more about; would you prefer a speedy recovery? Or would you prefer a longer, but much less painful one?

Back in College I took an Injury Management course that taught us the physiology and mechanisms behind injuries and how they heal. One of the most important points that stuck with me was how inflammation is necessary to heal an injury. I'm not going to bore you with scientific jargon so here's what you need to know:

    •    Blood needs to flow and swell to the injured area because it is full of the new building blocks, nutrients, and cells that heal the injured area.

    •    Rest and proper nutrition are necessary in a healthy and speedy recovery.

    •    Most of us know that cold slows things down (decreases blood flow) and heat speeds things up or increases movement (blood flow).

    •    Using cooling strategies will prevent or decrease inflammation, decrease pain, and increase ROM (range of motion).

How can R.I.C.E. be the best way to heal an injury if it prevents the inflammation that is necessary to completely recover? I continued to recommend this strategy for some time- after all, many athletes, strength coaches, and therapists were using this method until more recent research suggested the opposite.

Many studies emerged from trustworthy scientific journals with evidence to support that cold/icing/cryotherapy might not be best for recovery in many physiological markers. Most importantly, Cryotherapy is not effective for decreasing the reduced strength from heavy exercise,  decreasing the recovery time of injuries and may not be effective in reducing DOMS (delayed onset muscle soreness). Cryotherapy can also negatively affect the neuromuscular system. Less feedback from the nervous system can interfere with movement patterns among other things, leading to a decrease in muscular activation and performance.

It has been shown that cryotherapy does not improve endurance training, and actually decreases strength training adaptations (aka strength and muscle gains)

Having said that, there are some cases in which you might prefer to use cryotherapy to your benefit. Cryotherapy has been proven to decrease pain. It has also been proven to increase the ROM of a joint due to the fact that it reduces inflammation. It's important to note that this is only if an injury is present. It will not help you increase ROM in the long-term. Think about the main reasons we warm-up! To increase the temperature, blood flow and synovial fluid of the working area which helps increase ROM. It may also help remove metabolic waste and improve muscle oxygenation. There is some evidence that suggests cryotherapy (via cold water immersion and other treatments) may help improve recovery in athletes who perform multiple games or workouts in a day (short-term). This might be due to the lower inflammation levels, or the quicker removal of metabolic waste which allows for better work capacity and overall improved performance.

Which makes sense and leads directly into my next point...

If you've suffered from an injury you'll know how painful and debilitating a swollen joint can be- this is why some athletes still use cryotherapy. Depending on the situation, an athlete might want to decrease pain and inflammation to stay in the game, or play a day or two after a small injury. If you’re an athlete and it’s the off-season, chances are you'll want to use Heat and Compression to increase blood flow to the area and provide it with the proper nutrients to heal optimally. (We will talk about that in next weeks post)

CRYOTHERAPY RECAP

PROS:

    •    Reduces Pain

    •    Increases Short-Term ROM

    •    Able to Return to Physical Activity Sooner

CONS:

    •    Slows Down Total Recovery Time of Injury and Gains

    •    Decreases Blood Flow to Injured Area

    •    Decreases Neuromuscular Activity of Injured Area and Muscles Worked

Ultimately, it's up to you to decide whether you prefer to use Cryotherapy or not. Hopefully you don't injure yourself, period, but shit happens, so choose your healing method wisely. Stay tuned for next week’s article where I will introduce a newer, proven method to optimally recover from an injury.

REFERENCES:

1. Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury a systematic review of randomized controlled trials. The American journal of sports medicine32(1), 251-261.

2. Meeusen, R., & Lievens, P. (1986). The use of cryotherapy in sports injuries. Sports medicine3(6), 398-414.

3. Algafly, A. A., & George, K. P. (2007). The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British journal of sports medicine41(6), 365-369.

4. Ruiz, D. H., Myrer, J. W., Durrant, E., & Fellingham, G. W. (1993). Cryotherapy and sequential exercise bouts following cryotherapy on concentric and eccentric strength in the quadriceps. Journal of athletic training28(4), 320.

5. Fischer, J., Van Lunen, B. L., Branch, J. D., & Pirone, J. L. (2009). Functional performance following an ice bag application to the hamstrings. The Journal of Strength & Conditioning Research23(1), 44-50.

6. Peluaga, M., Rubley, M. D., Holcomb, W. R., & Tandy, R. D. (2010). The Effect Of Cryotherpay On Eccentric Peak Torque Recovery After Intense Eccentric Exercise. The Journal of Strength & Conditioning Research24, 1.

7. Tseng, C. Y., Lee, J. P., Tsai, Y. S., Lee, S. D., Kao, C. L., Liu, T. C., ... & Kuo, C. H. (2013). Topical Cooling (Icing) Delays Recovery From Eccentric Exercise–Induced Muscle Damage. The Journal of Strength & Conditioning Research27(5), 1354-1361.