Ask the Doc: Do You Know WHY You’re Icing?

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by MISSY ALBRECHT, DPT, CSCS, FMS| Physical Therapist/Coach

Ask the Doc: Do You Know WHY You're Icing?

“Healthy athletes should be better at clearing inflammation in the body than ice.” – Dr. Kelly Starrett DPT
Using ice has grown into a big debate: Is it helpful, harmful, or just a placebo? In the end, the answer is…well, it depends. But I see a lot of our athletes icing after the workouts, so I want to make sure you know WHY you are icing so you can decide if it’s helping you, harming you, or is useless.

What are the main reasons people ice? Usually to calm swelling/inflammation, to numb pain, and “to make sure I don’t hurt after a workout” (a.k.a pain prevention). We will get into whether ice helps those things, but let’s start with what icing does to the body physiologically.

The Body’s Physiologic Response to Ice: Strictly the Facts. [1]

When ice is applied to the body, the cold acts to vasoconstrict (narrow) the blood vessels. This causes reduced blood flow to the area, stopping swelling/inflammation. The cold sensation also affects the brain by blocking pain signals that may have been being sent to the brain from the injured area.

lymphatic-system-benefits-from-rebounding

Important side note: take note of where the nodes are located and make sure you’re not jamming lacrosse balls, barbells or any other mobility tools really hard into these areas. Those areas don’t like aggressive mobility, so be nice to them.

What is Swelling? [2]

Inflammation is a GOOD RESPONSE TO INJURY. We want it. We need it. Inflammation is the body’s way of sending help to the injured area so that it can heal.
Swelling is an accumulation of fluid, mixed with good things and bad things (waste) from the injury. The joints, muscles and lymphatic system help to take the fluid back into the heart to flush it out of our system. Swelling becomes an issue when joints, muscles and the lymphatic system don’t work properly and when we are sedentary and/or in pain.

We’ve all been injured right? Either the pain stops us from moving, or we think that we shouldn’t move because we need to let our bodies heal. So we sit with _____ body part supported and don’t move; although we want to move, the pain is too much to handle. Consequently, we end up sedentary, thus allowing the waste product of swelling to accumulate — this leads to tissue damage and slow/no healing. This is why movement is so important: it allows for the evacuation of the fluid from the injured area back to the heart where the body can help dispose of it through the lymphatic system.

swollen-ankle

This ankle has some major accumulation of inflammatory fluids that need to be flushed out. This will not be accomplished by only ice-elevation-compression band. It needs movement too.

Why Icing May Have Negative Effects

Ice can definitely help with pain. It can also be used to help athletes recover when used in an ice bath during the 30 minutes following a tough workout/event.
Inflammation is a GOOD RESPONSE TO INJURY. We want it. We need it. Inflammation is the body’s way of sending help to the injured area so that it can heal. If ice is stopping inflammation, then why the heck are we using it when we want healing to occur? In theory, when we ice we are stopping a normal healing process in the body, even though our body is equipped with the necessary tools to be able to heal itself. This is the source of the more recent debate on icing and the reason why NSAIDs are not recommended (because they also stop good inflammation, along with causing other internal damage).

Something to also keep in mind, said by a very smart man:

“Healthy athletes should be better at clearing inflammation in the body than ice.” – Dr. Kelly Starrett DPT

We were engineered to have inflammation and heal without external aids. We need the help when we are unhealthy; when we are unable to rest long enough to recover from the injury; or when we continue to push through injury and cause more damage and excess/chronic inflammation.

When Icing May Still Be Helpful

Ice can definitely help with pain. It can also be used to help athletes recover when used in an ice bath during the 30 minutes following a tough workout/event. Research is touchy on this subject, which you can read a little about here and here on our blog. Contrast baths can also be beneficial (alternating ice and heat) to flush out the accumulation of fluid.

Alternatives To Icing

My Opinion

[I]cing for pain is okay, but only if you are doing something on the side to help figure out what is causing the pain and modifying as needed while it heals.
Ok, I know it’s all throughout this blog already, but I figured it would be a nice recap. I don’t think icing is terrible, but I do think twice about it before I use it or tell someone to use it now. I tell people to ice if they can’t bear the pain because I think it’s better than using medications, but I also make sure they are doing something to get the joint and muscles moving! I don’t think it will do terrible damage at the time of use, but repetitive use of ice could definitely slow healing and alter proper healing overall.

My main issue, which brought up this blog topic in the first place, is with those who ice after every workout. I do believe this could cause more damage than help, primarily because it is not allowing for proper healing after the workouts. The exception would be if you did a rockstar workout/competition and need the ice for the ice bath recovery theory described above. Secondly, I think many people are using it to help for pain relief from the workout or because they assume it will be painful later. I said earlier that icing for pain is okay, but only if you are doing something on the side to help figure out what is causing the pain and modifying as needed while it heals. “It” won’t heal and go away if you just keep icing it. So if you’re someone who does ice after workouts, make sure you know WHY and whether or not you’re doing it for the right reasons.

References

1. http://www.cet-cryotherapy.com/cryotherapy_physiologic_effect.html

2. Kelly Starrett’s video on how icing is bad

3. Tricia J. Hubbard and Craig R. Denegar. Does Cryotherapy Improve Outcomes With Soft Tissue Injury?J Athl Train. 2004 Jul-Sep; 39(3): 278–279

4. http://www.marksdailyapple.com/should-we-ice-injuries/#axzz2dOIKNd00 

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