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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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December 04, 2012

Should We Ice Injuries?

By Mark Sisson
126 Comments

I’ve said this before, but inflammation is a necessary response to injury. It’s the inflammatory response that increases blood and lymphatic flow to and from the injured tissues, bringing healing nutrients and inflammatory mediators and removing damaged refuse. It’s the inflammatory response that makes injuries hurt, which prevents us from using and re-injuring the injured area. And yeah, the inflammatory response can get out of hand and do more damage than the initial insult, but it’s ultimately how our bodies heal damaged tissues and recover from injuries. If we didn’t have an inflammatory response, we’d never get anywhere. This was the crux of a very interesting blog post by Kelly Starrett in which he questioned the typical use of ice after injury. In short, Kelly says that putting ice on a healing tissue is counterproductive because it halts or at least disrupts inflammation, which is really how we heal.

Do we want to use ice in order to reduce the inflammation incurred after a soft tissue injury?

Let’s establish what we mean by “inflammation” after an injury. We’re really talking about the inflammatory process, which includes pro-inflammatory and anti-inflammatory processes. It begins with the release of inflammatory mediators that cause vasodilation, or widening of the bood vessels, at the injury site. This allows more blood to arrive, and with it leukocytes and macrophages (types of white blood cells) to clean up the site and moderate the inflammation. More fluid at the site also means swelling, or edema, which, along with the increased sensitivity to pain, restricts movement and allows the inflammatory process to progress. But once that fluid is filled with waste products from cellular cleanup, it needs to be drained. That’s where the lymphatic system comes in. The lesser-known circulatory system, the lymphatic system removes all the waste products and excess fluid buildup caused by the inflammatory process. When the waste fluid is drained, healing can commence.

Since the lymphatic system doesn’t have a big multi-valved muscle in the center of the chest controlling the flow of fluid through its vessels, we need to get the lymph draining smoothly through other means, like elevating, compressing, or moving the tissue. What about icing? Kelly and his guest in that video above say that icing an injury promotes fluid build-up and restricts lymphatic flow. To reduce swelling, they like compression over icing, because the former doesn’t affect the lymphatic flow in a negative way.

How do these claims play out?

Icing a specific areas definitely disrupts the overall inflammatory process, lowering both inflammatory and anti-inflammatory cytokines. Icing muscles after a sprint workout, for instance, seemed to reduce levels of IGF-1 (an anabolic marker that usually increases after injury/exercise and improves healing/recovery), IL-1ra (an anti-inflammatory cytokine), and IL-1? (an inflammatory cytokine) while increasing levels of IGFBP-1 (a catabolic marker that breaks down tissue). Those are just markers, though, and an ankle sprain is not a sprint workout. But still – the responses to exercise and injury are based on the same inflammatory and anti-inflammatory mediators. If one’s affected, the other likely is, too.

As for lymph flow, it’s been shown (albeit in a reference I can’t fully access) that prolonged application of ice to tissue enhances the lymphatic vessels’ permeability, causing “backflow” of waste fluid back into the injured area, worsening edema, and potentially extending healing time.

So, is that that? Icing is bad?

Not so fast. With some injuries, it’s been shown to help. Clinicians are actually using cold therapy to induce hypothermia and reduce brain injury and mortality while improving the outcome in patients who’ve just had a stroke. Or after something like pelvic surgery (which is a traumatic controlled injury of sorts), cold therapy can improve erection function and reduce incontinence. Following “primary injury” (the stroke) the application of cold is preventing “secondary injury” (brain damage) to the surrounding tissues originally uninvolved in the initial injury. Though this secondary injury phenomenon also exists with soft tissue injuries, and ice therapy seems to work in its prevention, the window of opportunity for intervention is pretty small – perhaps just the first thirty minutes after the initial trauma.

Icing your ankle right after a really bad sprain to prevent secondary injury seems to make sense, but does it help with swelling and overall healing?

A 2004 literature review on the ability of cryotherapy to affect soft tissue injury healing looked at 22 eligible randomized controlled studies to determine if ice was actually helping, and the results were mixed at best:

  • Ice alone was better for pain after knee surgery when compared to no ice, but swelling and range of motion were not affected.
  • Ice was no more effective than rehab in reducing swelling, pain, and range of motion.
  • Ice and compression were better than ice alone at pain reduction.
  • Of eight studies that compared the two, there was little difference between ice and compression and compression alone.

They conclude that “based on the available evidence, cryotherapy seems to be effective in decreasing pain,” but evidence is scant for any further conclusions. Another review using many of the same studies had similar findings, noting that the vast majority of the available studies purporting to examine the effect of cryotherapy on soft tissue injury employ surgery patients with open injuries. The authors stress the need for more research using patients with closed soft tissue injuries – sprains, strains – rather than surgery patients.

And that’s the big problem: there simply isn’t a lot of real, hard research on how icing affects the types of commonplace injuries people actually get. And why would there be? “Everyone knows” that you ice a sprained ankle. That’s just what you do. What’s there to study? Thus, most of the research on “soft tissue injury” either preemptively accepts icing as efficacious or uses surgery patients with open soft tissue injuries when what we should really be looking at are people with ligament, tendon, and muscle strains and sprains.

One thing to consider is that ice is rarely used in isolation. RICE, the acronym that everyone seems to follow after an injury, stands for “rest, ice, compression, elevation.” It’s the standard advice you’ll hear from most PTs and docs: rest the affected area, apply ice, compress it, and elevate the tissue. Thus, many studies that seem to show efficacy for cryotherapy also use compression, making it difficult to disentangle the two. Is it the ice or the compression, or the combo of both doing the work?

Indeed, some evidence suggests that compression is key. I was unable to find many studies that compared compression alone, icing alone, and doing nothing, but there are several studies showing major benefit for compression and icing over icing alone. Most recently, subjects recovering from recent ACL surgery received either icing or compression+icing. The compression+icing group had better pain relief and a marked reduction in pain medication usage when compared to the icing group. However, an earlier meta-analysis found that while cryotherapy after ACL surgery seemed to help with pain, it did not improve range of motion or drainage. In other words, it was good for pain but did nothing to actually speed the healing process or get patients back to action. And in the one study I did find that isolated compression and icing, compression bested both types of icing – continuous cryotherapy and intermittent ice pack application – in the reduction of post-foot-or-ankle-injury swelling.

The problem with RICE, as I see it, isn’t that icing is in there, it’s that people focus way too much on the icing and do it way to the exclusion of compression, while totally misinterpreting the rest and elevation recommendations. You’re not supposed to stay completely immobile and sedentary with your iced leg up on the couch for weeks while watching bad TV. After the initial downtime, you need to move! As soon as you’re able to move without pain, you should be mobilizing the affected tissue. Don’t go hiking on a broken leg or swollen ankle or anything, but don’t assume inactivity is best. Keep your movements pain free and unloaded to begin with. Rotate that sprained ankle. Flex and extend that hurt elbow. And so on. If you’re going to ice, keep it short and sweet and immediately after the initial injury. Err on the side of moderation. Most studies indicate that the coldest temperatures are less effective at reducing swelling and may even increase it, while the “cooler” temperatures were better at reducing swelling.

So, to answer the initial question: it depends.

Clearly, people aren’t losing limbs and whittling away their connective tissue despite the prevalence of icing after injury, so I don’t think the situation is that dire. It goes both ways, of course; people aren’t going to turn into shattered husks of their former athletic selves just because they neglected to ice an injury or two.

Ultimately, I don’t think icing is as unequivocally detrimental to the healing process. It can certainly reduce pain and, if that’s the only way for you to get the tissues moving, that’s a good thing (as long as you don’t move too much too fast and end up re-injuring the weakened tissue). And it can likely prevent secondary tissue damage, particularly if you apply it shortly after an acute injury. But the extended, constant, day-in day-out cryotherapy that some of us feel is absolutely necessary anytime a tissue feels less than perfect? No. It seems clear to me that compression and mobilization of the injured area are likely more important and effective than ice.

I don’t want anyone to subject themselves to a laboratory limb contusion or anything, but I’d be real curious as to how you Primal folks handle your injuries. Do you ice them? Do you let the inflammatory cards fall as they may, confident that the composition of your tissue fatty acids will provide a suitable inflammatory response?

Let us know how it’s been working out for you in the comment section! If there are any physical therapists or coaches out there, I’d be particularly interested in your take on this.

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105 Comments on "Should We Ice Injuries?"

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Wayne Atwell
4 years 6 hours ago

Interesting, I had never thought about how icing an injury might slow down healing but it makes sense. Just like taking cold medicine treats the symptoms but not the problem. The symptoms of the cold are what treat your cold so by removing them you slow down your recovery. Next time I sprain an ankle I’ll be sure to not ice it and I’ll let you know how it heals.

Chris
Chris
3 years 11 months ago

As a Massage Therapist and learning hydrotherapy and injury recovery, the common mistakes with icing an injury is that people leave the ice on too long, 10 min at a time is recomended! Ice is a vasoconstrictor which pushes the fluid and edema away from injured area, after 10 min, removing the ice allows the vessles to dialate and the healing cells come back in. Think of it more like circulating something that would otherwise stay stagnant, speeding up the healing process.

Matty
Matty
4 years 6 hours ago

When I started Crossfit,ice didn’t help a lot but upping my Omega 3’s helped a ton.

Wayne Atwell
4 years 5 hours ago

So are you saying that the omega 3 helped you recover from lifting faster? That would make sense, the extra omega 3 would reduce inflammation.

Logan
3 years 11 months ago

But isn’t THAT inflammation you are referring to necessary for healing?

lockard
lockard
4 years 3 hours ago

interesting point. maybe teams should O3 together rather than ice bath, or whatever_____ insert tradition ____here, they think is helping their team do well

Alexander
Alexander
4 years 6 hours ago

Two weeks ago, I had lateral meniscus surgery and have been told to ice my knee as much as possible, so this article is of particular interest to me right now. The ice makes me feel better, and along with compression, improves range of motion. Is this fooling my body?

Joshua
Joshua
4 years 2 hours ago

you might only be increasing your range of motion beyond a safe level due to numbed pain receptors.
I try to avoid any painkillers at all because I want to know what activity is safe and what makes it feel worse. Advil doesn’t make it better it makes it FEEL better.

SayMoi
SayMoi
4 years 2 hours ago
Me too! I just had medial meniscal surgery yesterday and have been searching for the answer to this very question. This was excellent timing. 🙂 What my research found, though, was that inflammation is by and large a much better response to OPEN wounds because it works so hard to prevent bacteria and infection. Modern sterile arthroscopic surgeries are their own class. I also learned that without ice, the swelling rapidly leads to scar tissue, which can be awful to try to breakdown later on and resume full range of motion. I’m at least cooling and compressing for the time… Read more »
Toby Edge
4 years 6 hours ago

I’ve badly sprained both of my ankles before. On one occasion I iced it straight after. One the other I didn’t. Interestingly, it wasn’t so bad the time I didn’t ice it. Something i’ve never really thought about before…I’m going to look into this a bit more!

Wayne Atwell
4 years 5 hours ago

Did you sprain them both at the same time? If so, you should have iced one and not iced the other to see which one heals faster. The first clinical test.

Nikki
Nikki
4 years 1 hour ago

If he managed to sprain both at once, I am more interested in the story about HOW.

Wayne Atwell
3 years 11 months ago

I once sprained both ankles at once. I was playing lacrosse and running down the field. It hadn’t rained in weeks so the ground was so hard that I sprained both ankles.

Zusiqu
Zusiqu
3 years 11 months ago

Snowboarding can cause dual ankle injuries.

TRUENORTH
TRUENORTH
3 years 11 months ago

I have always been an athlete and NEVER believed the current concept of ice on an injury. I was delighted to read that someone actually believed the same and for the same reasons.

I find that the correct pressure points do a much better job and stop it (especially a sprain) before it gets started.

Burn
4 years 6 hours ago

My experience… I’ve had tendonitis a few times and I’ve tried ice because I was convinced it had to work. And it didn’t. I didn’t notice any benefit from it, and I suspect it may have slowed my healing.

Shary
Shary
4 years 6 hours ago
I’ve had a lot of sprained ankles over the years due to an inherited structural problem called varus heels. Long story made short: The bottoms of my heels are slightly rounded rather than flat, which can result in a supination problem that contributes to spraining (according to the podiatrist). Anyway, I’ve never much bothered with icing a sprain. I’ve used ace bandages for a day or so for added support and to help reduce the swelling, but as soon as it didn’t hurt to walk I was up and about, usually within minutes after the injury. I’ve always found that… Read more »
Audrey
Audrey
4 years 6 hours ago

This is very interesting. It would seem to confirm my instincts (once again!). I’ve never liked using ice, it just never felt right to me, often being more painful then the initial injury. But what I’d often do, after the initial swelling and pain were passed, was to gently massage the area – that seemed to release pressure and pain much more effectively – and I guess that was probably helping with draining. Then insisting on moving the affected body part gently but often to keep it mobile. Good to know my instincts were right!

bonita
bonita
3 years 11 months ago
instincts are great. a few years back i slipped on some ice while walking down cement stairs and landed on my back, slightly on my right side. easily the most excrutiating pain in my life. don’t know for sure, but probably did rib damage–didn’t see any point going to a doctor as pain was my only symptom. i pulled out some ice and put it on. soooo painful! i tossed the ice and found my zostrix. the pain had eased but it was very raw and my biggest fear was that it would stiffen (meaning more pain) up as i… Read more »
Kyle Sullivan
Kyle Sullivan
4 years 6 hours ago

I read this article using movement, elevation, traction, and heat to treat and rehab injuries.

http://www.t-nation.com/free_online_article/most_recent/radical_methods_of_injury_rehabilitation

Ragan
Ragan
3 years 11 months ago

I was just going to link to that exact article. My husband and I have both treated ankle sprains very successfully using the METH protocol. I am a firm believer.

rose
rose
4 years 6 hours ago

I suffered horrible back pain for years before I discovered icing. If I ice at the first twinge, it keeps my back from going into spasm. That and MDA and I’m good to go!

Jane
Jane
3 years 11 months ago

Yes I now use ice for bad backs, when I used to always gravitate towards heat packs. The ice recommended by my chiro, feels really wrong, but always if applied at first twinge, avoids full blow spasm.

Oly
Oly
3 years 11 months ago

I spray tight joints or my back with magnesium solution and make a point to have epsom salts in the bath.

Diane
Diane
4 years 5 hours ago

I had bursitis in my ankle/heel once and the doctor told me to ice it, rest and elevate it and take it easy for 6 weeks. I did that for one day and could tell that was the wrong thing to do. Instead I did no ice, no elevation and I went for easy walks. The pain lasted only a few days. I also got metatarsal stress fractures once. I walked barefoot around my neighborhood and it went away in 6 weeks.

Shary
Shary
3 years 11 months ago

I would agree with this approach, though others might not. IMO, moving the injured body part as soon as it can be done without pain speeds the healing process because it promotes normal blood circulation, whereas icing probably does just the opposite.

Nocona
Nocona
4 years 5 hours ago

After a dozen ankle sprains through the years, icing immediately afterwards for one day only and then afterwards lots of massaging and gently rolling my ankle in circles both ways, gets me back on good footing with the world. Sometimes I put a bit of heat on the injury after the first day to help with the foot rotations.

Shana
Shana
4 years 5 hours ago

I’m a licensed Physical Therapist Assistant and they always taught us in school to ICE/RICE, I’ve always told my patients to ice also. I will certainly be researching this further. Thank you Mark for the interesting post 🙂

Dr. Mark
4 years 5 hours ago

I’m not someone that likes to artificially influence the natural reactions the body has to injury or illness, but I do sometimes recommend ice for its pain relieving quality. I don’t necessarily like it. I would much rather a patient let the body heal on its own. But we are a pain treatment society, and I would rather someone use ice than go for the drugs. Lesser of two evils I think.

Amy
Amy
4 years 1 hour ago
That makes sense to me. Our baby girl just had back surgery (long story.) It was clear that surgeon vastly preferred working on infants and small children, in part, because they don’t play head games with pain meds, unlike the adults. As for us, we felt any pain she was experiencing was necessary to keep her from moving too much. We let them do their “standard” pain treatment and when it was “on demand” we had no need to give her any more. She was sleeping and eating well so it was good enough for all of us. As much… Read more »
burrhead
burrhead
4 years 5 hours ago

With so many people visiting your website it must be tempting to provide definitive answers to readers inquiries. I appreciate it when you relay the information you uncover in your research even when it means you were unable to find an answer. Thanks for that.

Amy
Amy
4 years 1 hour ago

It’s very refreshing to get a “it’s complex and kinda ambiguous” answer on the ‘Net.

BootstrapsOnMyFivefingers
BootstrapsOnMyFivefingers
4 years 4 hours ago
I injured my knee on the first day of summer. Doc thought I tore something, but I just seriously aggravated the cartilage. I tried icing and taking Advil, but it was still very swollen. It wasn’t until I started wearing a compression knee brace that I could manage my pain. Wore the compression brace for 2-3 weeks. It helped tremendously with supporting the injured area, while still allowing me to walk. Whenever I took the compression off and tried to walk, my knee would hurt and swell. After 3 weeks, I used the compression only for re-establishing exercise (short walks)… Read more »
Francis
Francis
4 years 4 hours ago
Tom Bisio and Frank Butler talk about ice in their book, “A Tooth From The Tiger’s Mouth.” I highly recommend any active person read this book, which succinctly describes and explains how Chinese Medicine can be used for injuries like sprains, burns, lacerations, and even broken bones! Chinese Medicine warns against using ice because it slows the healing of injuries and may even cause worse problems later in life because of incomplete healing. According to their book, many techniques and medicinal liniments, plasters, salves, etc. were developed on the ancient battlefields. This battlefield medicine had to be fast and effective… Read more »
Amy
Amy
4 years 1 hour ago

I’ve used traditional Chinese Medicine before for a condition “incurable” in Western Medicine (Amenorrhea brought on by poor diet and using the pill). The right practioner knows what their doing. 🙂 The remarkable thing is that the practioners quite often test “new to them” treatments on themselves. I’d love to see Western Docs do that more often.

Peacemaker
Peacemaker
3 years 11 months ago

Well remember the ancient proverb? “Pain is weak energy leaving the body.” I live by that rule everytime I’m exercising or just experiencing pain.

Izzy
Izzy
4 years 4 hours ago
Icing anything does not come natural to me – it’s just not something it’s usually done where I come from. I never understood icing a sore throat with popsicles, too – it’s sipping hot herbal tea with honey that works. Icing a high fever? No, the most effective remedy is a rub with cider vinegar made with rose petals. I did get a very bad foot sprain a few years ago, and, after I wasn’t able to walk for a month, I went for accupuncture. The second acupuncture appointment did the trick, I went there limping and came back walking… Read more »
Jennifer
4 years 3 hours ago
I wouldn’t recommend ice – I would, however, recommend cold wet cloths – only as cold as you (or the injured one) can tolerate. The idea is that the coldness initially induces blood vessel contraction (and protects damaged blood vessels). It also helps to relieve pain. You would use cotton strips, immersed in cold water, then placed just over the injured area. Wrap with dry wool strips. The cotton will become dry, so it is important to keep rewetting it. The old time natural hygenists in the UK would use this hydrotherapy technique *exclusively* for just about any kind of… Read more »
sara
sara
4 years 3 hours ago
I’ve been having some SI joint pain since becoming pregnant with baby # 2 (well, since about month 5 or so). Basically, the ligaments on the right side of this joint are over-stretched and inflamed (likely due to the relaxin hormone kicking in already). What has helped me the most is strengthening the muscles around that area (to give the ligaments a break), but I honestly feel that ice helps too! It seems to calm things down a bit for me… I don’t get shooting pains when I ice in the evening and it seems to contract these too-stretched-out ligaments… Read more »
Tuck
4 years 3 hours ago

I did a post on this in July:

“Is R.I.C.E Paleo?”
http://yelling-stop.blogspot.com/2012/07/is-rice-paleo.html

I think you’re better off listening to music…

Beth
Beth
4 years 3 hours ago

A massage therapist once told me to ice for maybe the first day following an injury, then alternate heat and ice from there on in (like heat for a half hour, then ice for a half hour, sort of thing). She claimed this had sort of a “pump” effect. I have no scientific evidence to back this up, but I have found this to work pretty darn well and wanted to mention it in case anyone else cares to give it a shot.

emina
emina
4 years 3 hours ago

I hurt my shoulder playing volleyball yesterday. Personally I dont ice unless I am in A LOT of pain. I feel that there is no difference in the healing process and also : its Winter and its cold enough outside 🙂
I’m interested though in what Matty said, and I am going to try upping the omega-3s.

Penny
Penny
4 years 3 hours ago
I tried to treat a really painful and intractable case of tennis elbow (caused by tennis) by icing it after I played each time, but it didn’t budge for months. My elbow only grew weaker and more inflamed. Still icing daily, I visited an orthopedist, who recommended a lay off along with physical therapy. The PT employed therapeutic ultrasound, which provided no relief after several $$$ sessions, so I stopped going. I finally visited a bodywork person who does A.R.T., a soft-tissue massage technique. When I combined the A.R.T. treatments with a nightly HEAT session (via a heating pad) and… Read more »
Katie
Katie
3 years 11 months ago
As a physical therapist I learned that the lymphatic system is not used to doing so much work as is suddenly required of it when injury occurs. So icing pulls the reigns on blood inflow, allowing lymphatics to “catch up”. But i have always wondered why the body would not have evolved better. Did cavemen find ice in summer for injuries? Probably not. I think it is the typically poor western diet that causes OVERinflammation. I have always found it helps with my injuries, but started Paleo diet a few weeks ago, so next injury will test it. Very interesting… Read more »
Elias
Elias
4 years 3 hours ago

After ankle sprains, my basketball coach would have me do “shock therapy” where I would put my foot into ice water for 5 minutes, then immediately into hot water for 5 minutes. He said it was to help pull/push blood from the area, thus speeding my recovery. After reading this article, maybe he was ahead of his time.

Jeff
Jeff
4 years 12 minutes ago

Sounds like Contrast Bath Therapy. I’ve also heard of using ice packs and heating pads for a dry form using the same concept.

Vanessa
Vanessa
4 years 1 hour ago

Sometimes my right hand and arm feel swollen. I get relief when I am swimming in a cold pool. It’s not ice but has the effect of shrinking some of the tissues, which seems to help.

Gerry Gordon
Gerry Gordon
4 years 1 hour ago

Great article Mark! I am also a licensed PT, and I typically advise my patients to ice for 3-7 days following traumatic injury/sprain/strain. Possibly a week or two more following surgery due to the larger amount of trauma. I would agree that it has a larger benefit for pain relief than it does for swelling. The swelling has to recede on its own or be mechanically helped through compression or massage. After that initial acute phase it is important to start moving again as the joint will remain stiff. Gentle progressive movement will help strengthen and normalize the injured tissue.

Becky
Becky
4 years 50 seconds ago
Aside from tending my own, most of my experience with injuries is from working with horses in various disciplines. with racehorses and other superior athletes, we tend to use ice boots and alternate it with hot or warm therapy depending on the issue. These are mostly tendon sprains, not back soreness type of issues that are usually caused by a direct external influence. cold hosing or other cold wet therapy (standing in a cold creek) seems to work well also and the patients do seems to get some immediate relief. We tend NOT to wrap injuries that we treat with… Read more »
matt
matt
3 years 11 months ago
I really like this post. solid scientific evidence in the field i like to keep an eye on! I’ve learnt for the soft tissue injuries to apply the RICER policy, the traditional ‘Rice’ with the added “R” being Rehab. most people remember the RICE basics, so i find it’s important to fully explain the rehab; the importance of movement as soon as possible, even if it is just stretching the joint/muscle, so as not to lose functionality whilst it heals. It also throws into the mix the question of athletes/everybody these days using pharmaceutical anti-inflammatories to “recover” quickly from these… Read more »
Robert
Robert
3 years 11 months ago

Use DMSO instead

Wendy
Wendy
3 years 11 months ago

I’m a Physical Therapist and ice is not intended to be used for more than 24-48 hours post injury/surgery and it is definitely to be used in conjunction with compression and elevation. Beginning light range of motion should start within 24 hours depending on the type of injury and degree of injury. In my professsional opinion, ice in conjucntion with other modalities is beneficial and I have seen good results when ice is used as an adjunct modality to a complete rehabilitation program.

TC
TC
3 years 11 months ago
Wendy – As a fellow P.T., I completely agree with your well-stated comment. Mark – the question at hand was if icing disrupts the inflammatory process. As you noted, the research is poor in showing that thermal modalities (ice, heat, ultrasound) actually reach target tissues. If the application of ice fails to reach the target tissues, one could reason that it likely has little impact on the inflammatory process. To reiterate my fellow P.T.s, ice is great for pain management, but compression, elevation, and gentle mobilization are key following an injury. After surgery, many patients utilize a CryoCuff (or similar… Read more »
Charlayna
3 years 11 months ago

Definitely prefer compression over icing. Icing has never really helped with my previous injuries, but all other aspects of RICE (including moving once I’m able to) definitely do make a difference!

I went from a sprained ankle to starting P90X in 2 weeks without icing last summer!

Alicia
Alicia
3 years 11 months ago

What about heat packs?

I tend to get a sore neck fairly often (I know, I should upgrade to a better pillow, but what? I use memory foam for now).

I’ve found heat packs really help reducing the pain and increasing range of motion quicker. Any science behind this?

Harriet
Harriet
3 years 11 months ago
As a 62 year old woman who has been unfit most of her life and who has just taken up some vigorous exercise I have an interest in reducing post-exercise pain. I tried heat but found it made the pain much, much worse. Ice and cold baths reduced the pain considerably. But by far the most useful has been to wear compression garments during the excercise and for 90 minutes post exercise and to keep moving slowly and deliberately off and on over that time. The garments also stopped me putting on 200-500 grams in weight post exercise which was… Read more »
Kelly Starrett
3 years 11 months ago
Great article, great discussion. We continue to work hard to manage our athlete’s and patient’s swelling without ice. These protocols are particularly important to many of my tactical solider athletes working in hot, dry, austere environments without an icing option. Humans are such extraordinary healing machines that I’m sure we will continue to heal ice/no ice. Some bright friends have pointed out that an evolutionary argument isn’t a very good one. I do continue to question whether every human being’s inflammatory response to injury is a mistake that we should try to mitigate through icing. We are filming a follow… Read more »
Terry
Terry
3 years 11 months ago

in treating gout over the years I have not had success in reducing pain or inflammation until recently a physiotherapist introduced me to compression,cold-hot water therapy and light cycling to get the blood moving.Icing and elevation did not help at all.If the attack is severe the only relief is anti-inflammatories.At another time I will write you a success story because primitive blueprint program has relieved my gout completely for one year without use of any medications during the year.

Uncle Frank
Uncle Frank
3 years 11 months ago

Terry, I am also a gout sufferer and will be very interested in your program.

Frank

Terry
Terry
3 years 11 months ago
Hi frank By chance I met a wellness practitioner who also a gout sufferer,recommended to stay away from nightshade vegtables.I eliminated them in January of 2012.Before this I followed the normal gout recommendations from doctors and websites but had no success.I have suffered more than usual in the last 3 years up till 2012.I used colchicine and indomethacin for relief but only when needed.In 2011 I seemed to have to rely on using them more often and always had pains in right foot even while not incurring a full attack. Back to January 2012.While doing some research on nightshade vegtables… Read more »
Mary Beth
Mary Beth
3 years 11 months ago

I’m a midwife’s assistant…there is much conjecture about the use of ice versus warmth for the perineum after childbirth. Care to weigh in?

Donald
Donald
3 years 11 months ago
I have found with my 30+ years of teaching first aid and over 20 years delivering it (firefighter/EMT) that ice alone does wonders for lessening pain and bringing down swelling. When we bring patients into the hospital with a strain, sprain or break the doctor will always say, “Keep iceing that until the swelling is gone so I can put a cast/splint device on it properly”. I do recommend RICE to all of my students when they are treating a minor injury themselves. I have also seen ice bring down the pain greatly with patients that can’t tolerate pain medications.… Read more »
Richard
Richard
3 years 11 months ago
A very good analysis. I have been in athletics to varying degrees since high school and college, mainly gymnastics then and tennis and weightlifting now, and it seems to me that the lymph “pumping” is related to the movement of the surrounding areas. So compression is part of it, but so is, as you propose, the gentle movement. I stopped icing injuries long ago. It seems to me that nature did not intend us to ice our injuries. The idea that all inflammation is bad is, as you suggest, simply misguided. The pain after an injury prompts us to restrict… Read more »
Darrell
Darrell
3 years 11 months ago

It seems to me that, whatever the body does, it must not do in the interest of harming itself. So very often, people treat “symptoms”, that are really part of the healing process (fevers being a good example) I find myself “treating” my injuries less and less. I have yet to be disappointed by my body’s ability to recover.

Shelby
Shelby
3 years 11 months ago
I love reading the comments and hearing what everybody has been doing. I to never understood icing as I always assumed that it restricted blood flow and that doing that would slow healing. The injury needs all the good stuff that the blood can bring it and the temporary pain relief from the ice was not worth the slower healing. I get a lot of ridicule for my thinking but I stuck to it. I also try and not take any pain meds as I don’t like the way they make me feel and I always thought that pain was… Read more »
Edmund
Edmund
3 years 11 months ago

Hans Kraus. Read his stuff – move, move, move after injury. Great results.

Donald
Donald
3 years 11 months ago
To add to my previous comment. I guess no one is considering ligamnet tears, joint dislocations or small bone breaks (ankles, wrists, etc.) These types of injuries are often not obvious. Primative man would have no way of treating them, so the lymphatic fluids that collect in that area and cause swelling would, over weeks and months, solidify and become hard as bone. I’ve seen people in 3rd world countries with these deformities. In primative times those old injuries would limit the functioning of the limb to the point that the individual might not survive if he had to hunt… Read more »
Michelle
Michelle
3 years 11 months ago
Hi All, I’m an emergency nurse practitioner (and personal trainer) and have a fairly balanced view of ice. Personally I hate using it – too cold for me, the cold hurts more than the pain! I give patients a choice – if it helps, use it! If not, then don’t! I advocate compression/supportive bandage, the balance of rest and use, the absolute need for limb elevation and rest (with gentle ankle/joint movements). Partial weight bearing with crutches for a few days then weightbearing (still with elevation as much as possible and not going for long walks either!). Good article and… Read more »
Glen
3 years 11 months ago

I had a pretty nasty shoulder injury do to impact. I kind of nursed it for a while and it would not heal. When my doctor advised that I started exercising more it get better rapidly. I agree with you about keeping some mobility with injured areas.

CrazyCatLady
CrazyCatLady
3 years 11 months ago
A little bit different, but the same in the disruption of the natural process because “that is what we do.” This summer my son had swimmer’s ear. With a perforated ear drum we found out at the doctor. He presented with his ear hurting, and a fever. I gave him pain reliever, but it wasn’t bringing down the fever right away. It was summer, he was cold, offices are always air conditioned, so I let him take a blanket into the doctor’s office. First the nurse yelled at me that he couldn’t have the blanket on, because he had a… Read more »
SLC
SLC
3 years 11 months ago

Often, when I get a low-grade fever, I wrap up in sweat pants and a hoodie, turn out the lights, get into bed, and focus on relaxing fully while breathing deep and regular. Within ten minutes, I’m asleep. When I wake up an hour or two later, I always feel much better. Help the body do it’s work. It’s not rocket science. Medical people whose focus is on “relieving symptoms” are missing the forest for the trees.

anomaly
anomaly
3 years 11 months ago

I love this post! I’ve always been curious but have had trouble finding any decent research. I have never really iced my wounds.. for two reasons. For one it’s never made sense to me to slow down my bodies natural response, and also, I just don’t like the feeling. I have a high pain tolerance though so that could be another reason I’ve never found it necessary.

kenny
kenny
3 years 11 months ago

Now this is very informative and meaningful post. I also always ice whenever I got injuries in basketball cause that’s what I been practicing since child. And later on I got some tips on how to handle this kind of things, thanks to the one who posted this.

Just to share some helpful health tips that I am surely will help you, just go this site… MedicalHealthArticles.info
thaks

zen
zen
3 years 11 months ago

Tiger balm and compression if you’re a masochist .

They also talked about NSAIDs being really bad for the healing process.

Josh PT
Josh PT
3 years 11 months ago
I’m a physical therapist and I see injuries from sprained ankles to knee replacements. Everything I’ve read so far is pretty on point, but there is something missing. Modalities with a combo of ice, compression, and elevation works great with distal extremities like an ankle. If I’m working a game and an athlete sprains his/her ankle, I do a hivolt EMS in a ice bucket for 15-20min. immediately and see good results. The thing I see missing is one of the biggest reasons why you should ice after an injury: to prevent atrophy to the supporting musculature. Inflammation and edema… Read more »
Helga
Helga
3 years 11 months ago
How does the no-ice approach work for head injuries? We were always told to ice immediately and stay awake for two hours — preferably with someone else present to make sure we did! If you’re treating yourself, especially for training-related pains and strains, I think it’s a matter of personal preference whether or not you ice. I’m okay with run-of-the-mill pain and soreness from training, but I know from experience(s) that for sudden, acute pain I have to ice immediately. Several years ago I tore my ACL during MA training, and, despite the loud popping sound, thought I had merely… Read more »
hollyanne
hollyanne
3 years 11 months ago
Ice, ice baby. Heat is for pain relief. hence why footballers use it when they want to play a game the next day with an injury- the heat masks the pain. Good for chronic injuries. Ice is for controlling inflammation (as are the other 3 elements of RICE that restrict blood flow to the area). Good for new, closed injuries. Inflammation is the body trying to kill an axe with a mosquito. Kind of like the massive autoimmune response people had to the SARS virus. The immune reponse was so severe it killed people, even though the virus itself wasn’t… Read more »
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