De-Iced: The End of the Cold War

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by TONY BONVECHIO|MS, CSCS

Real World Results

Real World Results
In the worlds of sports medicine and physical therapy, it doesn’t matter what a textbook says unless it works in real life. But more trainers and therapists are seeing results without using ice on their patients and athletes.

Brandon Aiken, the assistant athletic director for sports medicine at the University of South Carolina Aiken, stopped using ice over three years ago and never looked back.

“It’s crazy to me how much research we have to support active recovery but still struggle to connect the dots that a cold bag of ice does nothing for what we absolutely know moves lymph fluid,” Nowlin said.
“From day one, in our basic athletic training class, ice was our friend,” Aiken said. “We had our baseball players come in all the time, icing their shoulders, icing their elbows. It got to the point where I asked, ‘Why are you doing that?’ They’d say, ‘I don’t know, I’ve always done it.’ Then I decided I’m going to stop icing things that aren’t hurt. We decided to stop using ice and it’s been fantastic for us.”

Aiken now relies on movement — not rest or ice — to get his athletes back on the field.

“Our first priority is to take care of our athletes and do the best thing for them,” Aiken said. “If we’re using ice, are we really doing that? My answer is no, we’re not. I have complete confidence in what we’re doing and our athletes have complete confidence in us because we’re seeing better results and faster recovery.”

Dr. Scott Kneeler, a U.S. Army physical therapist at Fort Bragg in North Carolina, phased out ice with his soldiers when they weren’t seeing results. Plus, ice proved inconvenient on the battlefield.

“The guys I work with are 100 percent results driven,” Kneeler said, adding that he now uses the MARC PRO instead of ice with his soldiers. “When they see the results, it’s an easy switch.”

Dick Mills, former Boston Red Sox pitcher and owner of Pitching.com, used to sell a popular icing product to his clients but has since abandoned ice for an active recovery protocol he codesigned with kinesiologist Angel Borrelli.

“In the late ’90s, we sold a ton of those ice things,” Mills said. “I think I was their best customer.”

But after talking with Dr. James Andrews, an orthopedic surgeon famous for operating on some of the world’s best athletes, Mills stopped icing altogether.

“I asked him, ‘What’s the research say on icing?’” Mills said, “and he said there’s no research to support that icing works. At that point, I stopped recommending icing.”

Dr. Chad Nowlin, a physical therapist in Commerce, Texas, recalls that during one of many internships, knee replacement patients experienced excruciatingly slow recoveries, even with the use of ice. But a switch to active recovery changed everything.

“I had one patient who we hooked up to the MARC PRO for 30 minutes a day, three sessions a week and that’s it,” Nowlin said. “Within a month, her operative knee looked just like her normal knee. It blew my mind.”

Stories like this give Nowlin hope that more therapists will ditch their ice packs in favor of active recovery methods.

“It’s crazy to me how much research we have to support active recovery but still struggle to connect the dots that a cold bag of ice does nothing for what we absolutely know moves lymph fluid,” Nowlin said. “If we could get that in heavier use in every setting, we will revolutionize outcomes for physical therapy.”

The Meltdown Continues

The Meltdown Continues

Mirkin believes that, deep down, most clinicians know that ice doesn’t work, but a burning need to do something for their aching patients prevents them from tossing their cold packs in the trash.
Reinl’s words have spread like wildfire, threatening to melt away ice’s position as the go-to recovery modality. A new legion of athletic trainers and physical therapists are using less ice than ever before.

Dr. Nathan Henry, a physical therapist at the United States Army base in Fort Benning, Ga., sees countless injuries during basic training and has taken a more hands-on approach to rehabilitation.

“We were really encouraged to use our manual skills and treatment plans that consist mostly of hands-on manual therapy and exercise programs,” Henry said of his education at Baylor University. “All we’re doing is facilitating the body’s natural process, that’s it.”

Henry recognizes that a shift away from icing will take time.

“Everybody within the sports community knows the acronym R.I.C.E., and it’s taken as gospel,” Henry said. “It’s a slow moving train. We need something to take the place of ice rather than just taking something away.”

Reinl may have discovered that something with his battle cry of “A.R.I.T.A.,” which stands for “active recovery is the answer.” Other methods like massage and laser therapy are promising, but all signs point to the fact that moving is better for recovery for sitting still — especially sitting still under a bag of ice.

Mirkin believes that, deep down, most clinicians know that ice doesn’t work, but a burning need to do something for their aching patients prevents them from tossing their cold packs in the trash.

“There’s a famous statement in medicine: ‘don’t just stand there, do something,'” Mirkin said. “And actually, it should be, ‘don’t just do something, stand there.'”

Mirkin’s words describe a common feeling of desperation for clinicians to get patients out the door with immediate relief, rather than facilitating the body’s natural healing process.

“Resting doesn’t help heal faster,” Mirkin said. “In fact, mild movement accelerates healing.”

Mirkin’s retraction of his R.I.C.E. protocol gives Reinl hope that his quest to rid ice from every athletic training room and physical therapy clinic may soon be finished.

“It’s a myth that’s run it’s course,” Reinl said. “The cold war is over.”

About the Author
Tony Bonvechio, MS, CSCS, is a personal trainer in Providence, R.I., and an intern at Cressey Sports Performance. A former college baseball player turned powerlifter, he earned his Master’s degree in Exercise Science from Adelphi University.
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