Should we be using Ice for injuries?
For as long as I can remember, ice (cryotherapy) has been the standard for treating acute injuries and sore muscles. While playing baseball in college the standard of care after a game was to ice a sore arm or stand in an ice bath with your knees submerged. If you were a pitcher, you received an ice pack for your shoulder as soon as you were done pitching for the day. I myself have also been recommending ice for acute injuries since I have been a practicing chiropractor.
Most of us know the acronym R.I.C.E (rest, ice elevation, compression) for acute injuries. The term was brought to us by Dr. Gabe Mirkin in 1978 in his best-selling book The Sports Medicine Book. Chiropractors, medical doctors, physical therapists, athletic trainers, and coaches have used this approach for acute injuries but now it appears that may not be the best advice. Recent studies show that ice (cryotherapy) may lead to slower healing times and delay recovery.
A simplified version of healing is as follows. When you injure a muscle, tendon or ligament your body has an inflammatory reaction to the injury. An example of this inflammation is when you sprain your ankle and it swells up. This inflammation brings many different players to the injured area. Let’s focus on one of the cells that help to heal the tissue. One type of white blood cell is called a macrophage. The macrophage has the role of finding the cells that have been damaged and destroy them to allow new tissue cells to grow.
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation. (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014).[i] The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve or tissue damage.
Anything That Reduces Inflammation Also Delays Healing.
Anything that reduces your immune response will also delay muscle healing. These are some examples:
Almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
Immune suppressants that are often used to treat arthritis, cancer, or psoriasis,
Applying cold packs or ice,
Anything else that blocks the immune response to injury.[ii]
Ice Also Reduces Strength, Speed, Endurance, and Coordination
Ice is often used as a short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance, and coordination (Sports Med, Nov 28, 2011). [iii]