De-Iced: The End of the Cold War

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Active Recovery and the Lymphatic System

Active Recovery and the Lymphatic System
Reinl’s message reached the masses via his video interview with Dr. Kelly Starrett, a physical therapist turned CrossFit icon. The owner of CrossFit San Francisco and author of New York Times best-selling book, Becoming A Supple Leopard, Starrett called his first meeting with Reinl a “seminal moment” in his career.

“We were talking about ways to optimize performance and everything Gary said about icing was so intuitively correct,” said Starrett, who had used his fair share of ice as a physical therapist and whitewater rafting national champion. “But I didn’t just take his word for it. I verified it for myself.”

Recalling a young basketball player who suffered an anterior cruciate ligament tear in his knee, Starrett decided to forgo icing in the rehab process, instead using active recovery methods such as massage and electrical stimulation. The results were surprisingly positive.

“My outcome with him was faster and better and I was ahead of any of the benchmarks we’d ever used, but that was just an ‘n’ of one,” Starrett said, referring to the variable ‘n’ that researchers use to quantify the number of test subjects in an experiment. The larger the value of ‘n’, the more reliable the results, so Starrett skipped the ice on more and more patients, producing similarly spectacular results. Between CrossFit competitors, Olympic gold medalists, military personnel and Tour de France cyclists, Starrett’s ‘n’ grew to thousands, solidifying his abandonment of ice as the right move.

“Our sports end up being our laboratory, and we need to take the information we’ve learned and translate it,” Starrett said. “It’s our failure to do so that’s been the problem. I’m a working physical therapist that treats problems and we’re always looking for the best practice. Turns out icing was not a solution at all.”

Ideally, Reinl says, people would use light exercise to jump start the healing process, but sometimes, pain or fatigue makes that impossible.
Now, Starrett and Reinl preach active recovery, using movement and light exercise to speed healing. Practiced by track athletes for years in the form of light jogging between sprint events, active recovery provides low-level stress to tissue, allowing it to heal and grow stronger.

“Active recovery is the answer and stillness is the enemy,” Reinl said. He points out that swelling is removed from the site of injury via the lymphatic system. Part of the circulatory system, the lymphatic system is a sprawling map of one-way vessels that carry fluid toward the heart, disposing of waste products that are eventually dispelled in urine.

But there’s a catch to the lymphatic system — it’s completely passive, meaning that it can only move waste when muscles squeeze lymph vessels. No movement means no waste removal. In fact, when you freeze lymphatic vessels, it creates a backflow that leaks fluid back into the space between cells and increases swelling.

Ideally, Reinl says, people would use light exercise to jump start the healing process, but sometimes, pain or fatigue makes that impossible. So Reinl created a training program for a machine that removes swelling while you relax, and some of the world’s top athletes and trainers use it religiously.

Athletes like Rich Froning, four-time CrossFit Games champion and holder of the title of “Fittest Man on Earth,” can be seen on the sidelines between grueling bouts of exercise using Reinl’s recovery program for the MARC PRO, an electrical stimulation unit that promotes active recovery by causing muscular contractions.

The MARC PRO, which boasts testimonials from the likes of Los Angeles Lakers head trainer Gary Vitti and Detroit Tigers head trainer Kevin Rand, helps the lymphatic system to flush waste out of injured tissues by triggering low-level muscle contractions, literally pumping “garbage out and groceries in,” as Starrett frequently quips.

An over-the-counter product designed to enhance muscle recovery, many clinicians exercise their right to use the MARC PRO off-label to treat injuries with overwhelming success.

What’s more, it turns out the pain-relieving properties of ice lead to a whole new host of problems.

Uncomfortably Numb

Uncomfortably Numb
According to Reinl, the numbing sensation of ice poses a serious threat to the healing process. If you’re an athlete who needs to recover quickly, he says, the relief isn’t worth the risk.

While the value of pain relief is a matter of opinion, one fact is indisputable: pain relief is not synonymous with healing.
“You’ve shut off the signals that alert you to harmful movement, so how would you know that the movement you’re doing is good or bad?” Reinl said, adding that painful movement often leads to further injury and increased healing time. “The answer is, you wouldn’t know. I liken the use of ice for pain control to the sympathetic bartender that gives the alcoholic a drink so he can temporarily feel better. You’re not fixing the problem, you’re making things worse.”

Pain acts as the referee for effective active recovery. For example, after spraining an ankle, gentle pain-free movement of the toes will likely speed recovery, but pushing the pain threshold with ankle circles may further injure the afflicted ligaments. Ice can block these signals, steering you off the path to recovery.

However, many clinicians agree that for the average non-athlete, healing faster is less important than stopping the pain quickly.

“If you’re talking about a competitive athlete, he has to get back to the field as soon as possible, so rest and ice are foolish because you delay healing,” Mirkin said. “If you have a casual exerciser who’s hurt, let him use rest and ice because they will decrease pain. They lose a day of healing, so what?”

Others aren’t so sympathetic. Some believe pain is necessary to keep you from hurting yourself more.

“Ice dulls the nerve sensors on the skin so it makes you feel better, at least superficially,” said Hisashi Imura, the head athletic trainer for the San Jose State University football team. “But deep down you’re not helping to promote healing.”

While the value of pain relief is a matter of opinion, one fact is indisputable: pain relief is not synonymous with healing. Research on non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen has shown that NSAIDs disrupt the inflammatory process by suppressing cyclooxygenase. This abates pain, but much like ice, can dull the warning signs that would otherwise prevent someone from moving an injured limb.

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