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What’s your opinion on some new research data that suggests you should skip icing an injury?
A deep look at the research behind icing is important for correct self-care. Icing does have its place in sports medicine for pain reduction and swelling control. Some animal studies show however, that aggressive icing of a new significant muscle injury can create additional scar tissue and delay recovery.
To understand what occurs with icing and swelling, lets look at a new injury. You sprain your ankle coming off a bouldering problem, missing the edge of the pad. No pop, you can stand and hop on it, you decide it is just a sprain. This ankle immediately begins to swell and feel warm. As with any new injury, it is sending out invisible chemical signals to the body to send backup to help it to heal. These chemical signals include calls for many different healing factors including the little cells called macrophages which will help to break up the damaged debris, as well as a call for specific nutrients to help rebuild the injured tissue.
With these signals for repair, swelling accumulates in the region. Due to this, most injuries have swelling and thus pain. It is a common past time to aggressively treat with ice to decrease this side effect, but does it work? Are there side effects we need to know about? Absolutely yes, to both.
In past years, ice has been shown to limit pain, swelling, blood flow, and metabolism in the injured tissue. As the research goes on, we are learning more about how inflammation and swelling control can limit pain and/or repair. With too much ice, we limit the ability of these healing factors to get to the injury site and thus, we have less healing taking place. Because of this, we don’t want to aggressively ice in the beginning of an injury, a cold wet towel and/or some compression with an acewrap or kinesiotape will suffice. With not enough swelling control, the area is larger, more painful, and a better indicator as to how much healing still needs to take place.
In Chinese medicine, it is believed that heat is always used (not ice) to allow the movement of energy and blood to and from the site of injury itself. They have believed for thousands of years that ice causes blockages and limits the body from healing itself. It’s amazing after all these years that we are learning why with our western minds and applying research to see that yes, this particular theory rings true.
If we choose to leave your new injury alone (barring no fracture or dislocation) and to treat it with compression, studies show it has the same positive results as icing without the side effects. Giving your injury a safe setting to get its job done, it will allow the knitting and the repair of your injured tissues to heal the best.
When is icing a good idea? To limit pain, it’s perfect to apply more ice after those first few days of a new injury. If you must ice, ice gently and with repeated short barrier-aided applications. For those areas that are visibly changing size or chronic in a way that they are not healing on their own, I tell my athletes to choose ice with the addition of compression for any areas that have swelling control issues.
In the three studies referenced in the review articles below, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Both decrease pain and swelling.This might mean that compression is just as effective as icing on its own. So yes, icing helps with pain but it needs to be applied with conservative techniques, including compression, and with repeated applications to be most effective.
References: 1. Tildus PM. Alternative treatments for muscle injury: massage, cryotherapy, and hyperbaric oxygen. Curr Rev Musculoskelet Med. 2015 Jun;8(2):162-7.
2.Hubbard TJ, Denegar CR. Does Cryotherapy Improve Outcomes With Soft Tissue Injury? Journal of Athletic Training. 2004 Sep; 39(3):298-279
3. The effects of multiple daily applications of ice to the hamstrings on biochemical measures, signs, and symptoms associated with exercise-induced muscle damage. Oaklet ET et al. Journal of Strength & Conditioning Research. 2013 Oct;27(10):2743-51
Dr. Lisa is a medical coach and climbing specific sports chiropractor out of Boulder, Colorado. A former member of the USAClimbing medical team and the author of the book Climbing Injuries Solved, she teaches reinvention and self-care for those suffering from chronic medical issues such as elbow tendonitis and pulley tendon injuries. See e-medical visits and links to her book at climbinginjuriessolved.com.
