Myth Buster: Icing Injuries
Ice gets FDA approval for cooling hot soup!
Icing injuries has been going on for so long now we are only doing it because we have always done it? But have we really evaluated if it works? What does the research actually say? And is what we are doing with ice helpful or not as good as we thought it was? When we are incing injuries are we helping the body do what it does? Or are we doing the opposite? When I ask someone why they are icing injuries the most common answer is to control inflammation. Is that something that can even be controlled in the healing process? And more than that, is it something we should want to control?
The body requires inflammation to heal. To try and control the inflammation like saying the body does not know what it is doing. The body is like mom. Mom knows best. Even when you think she doesn’t…she does. Inflammation has gotten a bad reputation over the years but the truth is this: If you don’t inflame, you don’t heal. So what is the real problem that people are trying to get to the bottom of? Is it inflammation, swelling, or pain? Lets take a dive into each and see where the merits of icing an injury falls.
Icing Injuries and Inflammation:
Inflammation is phase one of a 3 step healing process. These phases always occur in order and overlap to some degree. The phases are Inflammation, Repair, Remodel. During the Inflammatory phase the body is increasing blood flow to the injured area by creating new blood vessels. During this time the body is also sending numerous different cell types (neutrophils, macrophasges, eosinophils, etc…) to help clean out dead tissue and create a neutral environment for the “wound” to heal in. These cells are called inflammatory cytokines. These things pour in with the rush of new blood flow that is coming to the area. You can already start to see how having this blood flow increase and inflammotry cytokines are critical to this process.
Secondarily, these inflammatory cytokines signal the body to send the repair crew. These are the cell types that actually come in and start rebuilding tissue when appropriate and laying down scar tissue. Following the repair of the tissue is what is called remodeling. During this phase, the new tissue is being loaded repeatedly to become as normal as possible. Remodeling helps the tissue lay down in straight lines instead of being a jumbled up mess and ultimately increases the function of the tissue.
Inflammation is critical for the normal healing of tissue! If we don’t inflame, we don’t heal.It really is that simple. So we do we want to stop inflammation or slow it down? The answer is: We Don’t. And that is why we need to stop icing injuries. Best case scenario you are just slowing down the process of healing. You might be thinking now, well what about chronic and persistent inflammation after injury? Chronic inflammation is the hallmark sign of autoimmune disorders. If you do not have an autoimmune disorder then you do not have chronic inflammation. What you have is Injury Mismanagement. The body will inflame to the degree that it needs, and it will produce a certain amount of swelling secondary to that. To limit this process is asinine. So what about that swelling?
Icing Injuries and Swelling:
This is another common reason people give for icing injuries. But does it work? Over the past 6 years I have not used it one time in the clinic. I have seen it used with other clinicians patients over and over again though. So to answer the question”does it work?” Its a resounding NO! If it worked people would not have hot swollen joints for months after surgery or injury. People are getting iced down in the clinic 2-3 times a week for 12 weeks during rehab. And most are going home and icing on and off all day every day in between rehab sessions. So why are we still seeing big swollen joints for so long even with the use of ice? The reason is ice does not do anything to actually help the body remove swelling.
Swelling is removed through only one system. It is call the lymphatic system. The lymphatic system parallels arteries and veins and courses through our muscle tissue. In the trunk where muscle tissue does not surround the system, it still parallels the large arteries and veins in a our abdomen. The lymphatic system is a one way street in each limb and all streets lead back to the heart. Lymphatic fluid is moved when muscles contract. Period. There is no other way. So if you are trying to remove swelling with something that does not contract and relax your muscles, or get you large blood vessels pulsing, you are not evacuating swelling.
Simple fluid dynamics state that hot fluid flows faster that cold fluid. So to freeze the fluid around our injury and expect it to move better does not make any kind of sense. Especially not common sense. And knowing that muscle activity is what moves lymphatic fluid it seems double unreasonable to sit completely still with an ice bag on. Movement breeds movement. Stillness breeds stillness. To think we can make something move with stillness is faulty way of thinking. That is why we have been fooled by the ice bag for so long.
Icing Injuries and Pain:
Last on the list is pain. It is well documented that icing injuries decreases pain. There is nothing to argue. But clinically, there are 107 other things that we can do to decrease pain. So why choose ice? At home, there are 87 things we could teach our patients to do to treat thier pain without ice and NSAIDs. Those numbers are exaggerated but the point is that we don’t need to use ice for pain. There are plenty of other options available. The real question around using ice for pain is this: Are you slowing your healing times down for temporary pain relief? And maybe even this question: If we are truly solving the right problems around surgery and injury, why does pain linger for so long?
Simply put, the body is trying to increase blood flow, increase inflammation, and use pain free muscle movement to do it. Ice decreases blood flow, decreases inflammation, and decreases the contractility of a muscle. Research has never supported ice for injuries very well. When it has supported it well it was confounded or made null and void by human movement outside of clinical trials. Now more than ever research is stacking up against the use of ice and anti-inflammatory medications for injuries. Check out this video that explains some of the science behind how the body heals and how ice is counter to it. We will also dive into the poor protocols around icing an injury and what that means for different body types.
Are you having pain and trying to cover it up with ice and meds? Its time to get to the real reason behind your pain. Click HERE schedule an appointment!