Have you ever iced an injury?
Do you think that it helped?
Could you tell if there was less swelling?
Could you tell if it prevented further damage?
In his book “Iced”, Gary Reinl explores the background story of ice, the current rationale for icing and what the scientific research says about ice for the treatment of acute injury. I’ve summarized the key points from the book below. Though most of us have always used ice, likely we’ve never questioned if it actually aids the healing process following an injury. There’s no question that it may “numb” the pain and decrease soreness but does it do anything beyond providing temporary pain relief?
Unfortunately it is extremely difficult to personally observe whether or not it decreases swelling, accelerates healing or prevents further damage. Interestingly enough, after about 40 years of widespread use there is still no indisputable evidence to support the notion that ice improves recovery. In fact many studies have determined the exact opposite to be true and propose that ice may actually interfere with the healing process.
A little physiology is important to understand why ice may not be the best option when managing an acute injury. Following injury the body undergoes 3 phases of healing:
These are important processes and normal healing is impossible without the completion of all three phases. Following an injury, the body responds by releasing chemicals, which start the inflammatory process. These chemicals cause an increase in blood flow by dilating the nearby, undamaged blood vessels. This blood vessel dilation is important because the increased blood flow brings in the clean up and repair supplies (various cells) to the injured site.
Since ice causes vasoconstriction of blood vessels it may halt or stall the inflammatory process and or prolong recovery from injury. Ice is also traditionally used to reduce swelling. The key thing to understand is that inflammation and swelling are not one in the same. During the inflammatory process, an initial increase in fluid or swelling is normal. However, when we are injured and in pain our natural tendency is to avoid movement. A lack of motion allows waste products to accumulate and this is when swelling becomes problematic.
What removes excess fluid or swelling is the lymphatic system. The lymphatic system is a passive system and requires muscle activation to move the fluid out once it has entered the lymphatic capillaries. Research is ever changing there is more to be learned about ice and how it influences the healing process. Following injury we believe that active pain-free movement, pain-controlling modalities, light isometrics and nutritional interventions are the way to go. If you need ice for pain control go right ahead! The positive and or negative impacts are not well established enough to make a definitive decision.
As the recovery and repair phases begin, other manual therapy interventions are important to promote ideal healing of the damaged tissues and to restore and maintain proper joint function. The key here is to always seek out a manual medical practitioner following an acute injury so that you can ensure proper healing and prevent chronic pain or dysfunction.