Like any good prosecutor, Reinl has done his homework. Armed with the lack of evidence for ice’s efficacy, along with the bold anecdotal testimonials of some of the brightest minds in sports medicine and human performance, Reinl gladly dismantles the concept of icing piece by piece. Accustomed to fierce skepticism, he starts with a simple question.
“What is your intent?” Reinl always asks naysayers. The typical response is to reduce swelling or inflammation, which Reinl counters with another question: “Why would you want that?”
The Truth About Inflammation
This game of cat and mouse eventually leads to Reinl’s explanation of the body’s innate ability to regulate how much inflammation is needed to start the healing process. After millions of years, Reinl contends, our bodies can heal themselves without a bag of ice.
“Inflammation can occur without healing,” Reinl said, quoting a 2003 article from The Physician and Sportsmedicine journal, “but healing cannot occur without inflammation.”
According to Dr. Craig Denegar, director of the Doctor of Physical Therapy program at the University of Connecticut, inflammation has been misunderstood for years.
“When I was in school in the ’70s and ’80s, the biggest problem with how we managed injuries was the understanding of inflammation,” Denegar said. “The thing about ice is that it’s an ineffective anti-inflammatory. If it was effective, we’d have people falling apart.”
That’s because inflammation is an essential part of the body’s natural healing process. Without inflammation, cuts wouldn’t seal, fevers wouldn’t break and muscles wouldn’t grow bigger and stronger. Crack open any physiology textbook to the chapter on the immune system and you’ll find a list of three steps necessary for healing: inflammation, remodel and repair.
Stone, the former sports medicine program manager at the National Academy of Sports Medicine, works with experts to create textbooks for the higher education market. During his six-year stint as an athletic trainer, first at Long Beach State University and then at San Jose State University, Stone abandoned the use of ice after a trip to Switzerland, where he observed a full staff of athletic trainers use no ice at all.
“When you look at the science behind ice, there’s nothing that says it’s beneficial,” Stone said, citing a 2013 National Athletic Trainers’ Association position stand that, after evaluating all the existing research, concluded that using ice to treat ankle sprains lacked any scientific evidence.
The first step towards healing, inflammation is triggered when the body senses a harmful event, specifically injured tissue. White blood cells like neutrophils and macrophages, which Reinl dubs the “cleanup crew,” rush to the injured site to sweep away debris and bring healing nutrients. Damaged vessels constrict to quarantine the injury, while surrounding vessels open up to let nutrient-rich fluid in, causing the initial swelling.
Dr. Robert Otto, a professor of exercise science at Adelphi University in New York and co-author of the American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription, works with a wide range of populations, from triathletes to cardiac rehab patients, and recognizes the key role of inflammation in the recovery process.
“Some people say if you reduce inflammation, you’re going to heal faster, but from my perspective, the inflammation is there for a specific purpose,” said Otto, who adds that ice only penetrates a few centimeters beneath the skin, limiting the effect of ice on deeper tissues. “I’m not an advocate of ice. If you can tolerate the discomfort, let your body naturally heal as opposed to ancillary methods to mask the symptoms because sometimes masking symptoms just prolongs recovery.”
Otto notes that applying ice to the skin triggers a cycle of vasoconstriction and vasodilation where the blood vessels squeeze and relax, called the hunting reaction. Thought to create a rebound effect that theoretically increases blood flow, which spurred the 20-minutes-on, 20-minutes-off approach to icing, this cycle simply causes blood flow to return to baseline once the ice is removed.
“Do you really believe you need to regulate your body’s inflammatory process?” Reinl chides. “You think you’re better at it than the body is?” This rhetorical question is reminiscent of the works of revolutionary physiologist Walter B. Cannon, who coined the term “fight or flight” in his 1932 book, Wisdom of the Body.
Dr. Nicholas DiNubile, an orthopedic surgeon who served as the special medical advisor on physical fitness to the first Bush administration, cites Cannon’s teachings as highly influential in his shift away from ice at his Pennsylvania practice.
In fact, ice is so effective at delaying the healing process that JC Santana, a world-renowned strength and conditioning coach specializing in combat athletes, uses ice with his mixed martial artists specifically to stop healing when they get hit in the octagon.
“If you hit me with a shot in the eye in the first round and I need to go 10 rounds, I want to delay the recovery process,” Santana said, “because if that eye swells up in the second or third round, they’ll stop the fight because I can’t see. So in that case, ice is very appropriate, because you want to stop the recovery and inflammation.”
But for anyone who doesn’t throw punches for a living, there may be a better way to treat bumps and bruises.