ice pack 2There has been a long standing debate among everyone from doctors to athletic trainers whether to heat or ice an injury. While there is still a great deal of misinformation on the subject, this post is intended to simplify the whole situation…

Basically, never, ever use ice. Period. End of story.

The notion of icing an injury traces back to Dr. Gabe Mirkin, former assistant professor at the University of Maryland, who wrote “The Sports Medicine Book” in 1978. In it, Mirkin coined the mnemonic R.I.C.E.Rest, Ice, Compression and Elevation. This handy (albeit wrong) bit of “wisdom” quickly became the golden rule within all levels of sports competition and continues to be widely used today.

Over the past several decades, however, the first two components of R.I.C.E. – Rest and Ice – have been found to be completely wrong. Rest has long since been abandoned as it’s been well documented that exercising (i.e. moving) an injury helps it to heal and aids the lymphatic system in draining fluid from swelling. Indeed, even after major surgeries like knee and hip replacement, patients are often in rehab within hours of waking from anesthesia.

Ice, however, continues to be used by everyone from professional athletes, coaches and trainers to chiropractors and physical therapists. But the data simply doesn’t support it. Even Dr. Mirkin has been quoted as saying that they now know that the only thing ice does is numb the pain of an injury – and in so doing, can actually slow healing. Recent findings from both the British Journal of Sports Medicine and The Journal of Strength and Conditioning Research agree.

Instead of resting and icing a joint or muscle, it’s better to gently move/exercise, elevate and heat the injured area. And according to Manu Kalia, Physical Therapist and Ayurvedic Herbalist, these are also long-held standards of Eastern medicine.

But I’m sure you’re still screaming “What about the swelling?!?!

Well, what about it? Why is swelling such a bad thing? Swelling is the body’s natural inflammatory reaction to bring in fluids and healing proteins to the site of an injury. Unfortunately, too many doctors and sports specialists act like swelling is some uncontrolled bodily reaction that will somehow spiral out of control if left to its own devices. But it just isn’t so. Swelling is self limiting, meaning that it stops when its job is done.

By contrast, heat promotes blood flow, which brings with it prostaglandins, macrophages and growth factors, while movement helps the lymphatic system to pump out the swelling. These two modalities will hasten healing and have an injury feeling and functioning better faster.

So why do humans think they know better how to regulate the natural inflammatory process?

Well, for starters, the original idea behind icing, besides the fact that it numbed the pain of an injury, was the theory that the ice caused the veins in the surrounding tissue to contract, thereby slowing swelling. Then, when the ice was removed, the veins overcompensated by dilating and rushing in blood and nutrients.

The flaw in the theory, however, is that the proteins brought in from swelling are not only beneficial to healing, but are too large to be removed via blood vessels; only the lymphatic system can drain them (along with the toxins and damaged tissue they take with them) – and the lymphatic system is completely shut down by the combination of rest and ice!

Now, rather than take my word for it, here is a tremendous video by Dr. Kelly Starrett discussing this very topic and what made him abandon the R.I.C.E. paradigm:

More reading on the subject:

Why Ice Doesn’t Help an Injury

Never Ice an Injury

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