Updated: Oct 15
No seriously, STOP!! What's the most common thing we do when we sprain an ankle or strain a muscle...…..we ice!
Now before you throw your hands up in disbelief and scream at the top of your lungs how ridiculous that statement is, hear me out. Ice is not what you think it is. It is NOT helping the healing process from injury and in fact, an overwhelming amount of research shows it does the opposite! Other than temporarily numbing the sensation of pain, ice delays healing and recovery. But before you take my word for it, let's take a deep dive into the history of icing and why its use became "conventional wisdom"
From a young age, we're taught that if something hurts, you put ice on it. If you sprain your ankle at footy practice, wrapping a bag of ice tightly around the injured area is the first step to feeling better! We do this because we've been told icing helps reduce harmful inflammation and swelling and even kick starts the recovery process after intense workouts.
It's not uncommon today to see the best athletes in the world post-game interviews with bags of ice wrapped around their knees or shoulders. With a simple Google search, you can easily find photos of Michael Jordan with ice on both knees. Of course, we all started to use ice! As the saying goes, we all wanted to "be like Mike."
As a high-level rugby player, I commonly used ice on my sore body after intense training sessions and games where my body has been put through the rinser. I was told this was a "normal" part of being a top athlete. We would even jump into ice baths after games to help kick start the recovery process....or at least that's what I thought I was doing!
In the rehab world, physios, chiros, and osteos use ice every day in the clinics and training rooms across sports. In my early career as a Soft Tissue Therapist, it wasn't uncommon that every one of my patients would get a cold pack wrapped tightly around their injury after their session - to help "reduce" swelling!
However, the profession that has been using ice the longest is the medical field. Published articles dating back to the early 1940s explain that doctors would commonly use ice to help decrease infection rates, block pain and reduce the rate of dying on the operating table during amputation surgeries. This is because ice slows down cellular metabolism, allowing surgeons to keep as much muscle tissue alive as possible. While ice was originally intended to preserve severed limbs and decrease complications in the operating room, it would eventually sneak its way into being used for ALL injuries! For decades this has been the go-to method to quickly fix our injuries. The popular term that was invented is called RICE. RICE is a mnemonic acronym for four elements of treatment for soft tissue injuries: Rest, Ice, Compression & Elevation. The mnemonic was introduced by Gabe Mirkin in 1978. He has since recanted his support for the regimen. In 2014 he wrote, "Coaches have used my 'RICE' guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping. In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage."
Now if you were to ask a medical doctor today why they recommend ice for the common ankle sprain or backache, they'll likely say it helps alleviate pain, reduce inflammation, and restricts swelling. In fact, this is why some surgeons insist their patients use ice for months on end after surgery.
If literally everyone is using ice, how are we so wrong about it?
There is no denying that ice provides temporary pain relief. Slap an ice pack on an area of your body that is in pain and instantly you're going to start feeling better. In fact, if you look at the scientific research out there on the use of ice, a reduction in pain is the number one benefit! The ice helps to numb the injured area and decrease any kind of pain. But here's the deal - just because the pain is decreased does not mean you're fixing the injury. In fact, you're actually doing more harm than good. But, the main reason we use ice is to reduce or stop swelling. Our body's natural process of healing is to swell up, so in most circumstances, swelling is actually a good thing. We've always been told that inflammation and swelling are bad things that we need to stop as soon as possible. I'm here to tell you today that these are not bad things! The ice is stopping blood flow to the injured area, but it needs blood to help heal faster. Think of frostbite in your fingers, they are sooo damn cold, and blood is restricted to the area and so will eventually die! Once you get any kind of soft tissue injury the body is now in protection mode and the swelling is playing its part to shut down muscles and limit movement.
Ask any medical professional what the three phases of healing are and they'll all tell you the same thing: inflammation, repair and remodel. Don't believe me? Check any medical textbook and you'll find the same answer. Inflammation is the first stage of the healing process no matter the location or severity of the injury in the body. If this is a normal response to injury, why do we want to prevent it?