By avoiding ice, we can now see injuries that typically take a month, settle in as little as a few weeks. As mentioned above, the body relies on the passive Lymphatic system to remove the swelling. This is advantageous for better sleep, decreased stress and overall recovery. The idea is simple. Tissue Repair and Remodeling The next stage involves regeneration and remodeling the injured tissue. So we should avoid it where possible when recovering from injury.An ice bath will still dampen vascular and muscular adaptations despite commonly associated with post-workout recovery. While certainly not ideal and most likely counterproductive, ice should not be demonized. When in this exhaled state place your hand over the injured area and focus on it. It needs muscle activation and movement to pump congestion away. Compression bandages, compression socks, and stocking may not be the most effective way to overcome swelling. This is despite the man who invented the phrase - Dr. Gabe Mirkin, recently coming out and stating he no longer believes this to be useful Does ice help inflammation? Having said that, it really depends on what your goals are. If used respectfully it won’t hurt you and it won’t stop your injury from recovering anyway. Drugs: While not an official member of the RICE protocol, we often associate anti-inflammatory and pain-relieving drugs with acute injury management. Inflammation: The first phase is the inflammatory response initiated by our immune system. Physiotherapy has several goals including promote healing, reduce pain, avoiding aggravation, optimising physical function and global strengthening to restore normal movement patterns. Much like putting a tube of toothpaste in the freezer, ice makes congestion harder to remove. But as you can now hopefully appreciate, we seriously need to consider whether ice has any role to play in acute injury management at all. There are times when ice can be used effectively, but these are special circumstances where optimizing and preserving immediate short-term function takes priority. Furthermore, Gary Reinl suggestions ice can make surrounding cells more ‘leaky’ leading to greater congestion and swelling – not less. So what went from a relatively common footy injury, ended up costing the young player his leg. Again, ice should no longer have been used once the arm was re-attached and healing became the bigger priority. 1. Inflammation is not only normal but vital for healing to occur. So not only may ice delay the inflammatory process but it may also decrease the body’s ability to effectively remove waste and congestion. In 1962, 12-year-old Everett Knowles was boarding a freight train in Somerville, Massachusetts. It’s worth noting that pain will reduce once we remove the swelling, so it makes sense to invest your attention there as well. In fact, after I outline my thought process below, you may wonder how you ever thought icing an injury … Required fields are marked *. If there’s more swelling than expected, perhaps it’s better to ask why the swelling is not being removed as effectively as it should be. So not only may ice delay the inflammatory process but it may also decrease the body\'s ability to effectively remove waste and congestion. Furthermore, Gary Reinl suggestions ice can make surrounding cells more \'leaky\' leading to greater congestion and swelling - not less. But it all depends on your immediate goals. Otherwise, there’s no healing. Here’s what happens to the healing process when you ice an injury: We know ice restricts blood flow. The harsh reality is that as soon as we remove the ice and the tissue re-heats, the inflammatory process continues anyway. Simultaneously we see dilation of the healthier, surrounding vessels to allow the body\'s \"clean up crew\" to come in a do its work. But here we are anyway. Again, the passive Lymphatic system needs muscle activation to facilitate swelling removal. Have you ever stood with your arm up in the air for a few minutes? As most will know, we often ice an injury based on the RICE method – the most recognizable protocol in Western Medicine. This is also why we want to avoid pain relief if possible. The RICE acronym was originally created by Dr. Gabe Mirkin – a Doctor of Sports Medicine from the University of Harvard over 40 years ago. Because in this specific instance you do want to try and delay the inflammatory response. We need pain and inflammation for optimal healing. Clearly heat will increase blood flow to the injured area, but in a similar vein to ice, we don’t want to dictate terms to the body. As we’ve already mentioned, ice may, in fact, delay almost everything to do with the healing response. The above ideas don\'t match our physiology. It\'s genuinely one of the most valuable techniques I\'ve ever seen or used. It may, in fact, be doing the opposite. The buzz word here is \'relative rest\'. After all, decades of Sport’s Medicine have consistently told us this. But if we think in terms of basic health common sense, the idea isn't outlandish at all. In a few words - not really. A gentle, more superficial massage is fantastic to help flush out congestion in the area. They are not the norm. Apply ice directly to the injury. We also need to respect its relative intensity so that we don’t aggravate the damaged tissue. The next stage involves regeneration and remodeling the injured tissue. If you don\'t have a Voodoo Floss band, a theraband or old inner tube from a bike tire will also help. We’ve long thought that ice ‘helps’ inflammation, mainly because we see it as ‘bad’. Swelling is neither good or bad. The main benefit of applying ice to an injury is to help control or reduce pain. As a result, we need movement to best clear swelling, not immobility and general surface compression. When it happens, it hurts! The deeper the injury the longer you need to ice. Keeping the above in mind, the following are usually the four reasons we ice an injury: And we do this under the guise of the RICE protocol: Ice is known to be a very useful pain reliever and effective at restricting blood flow through vasoconstriction of blood vessels. Even if you don\'t, it\'s widely known you probably should. Going back a little further, Gary Reinl, author of Iced: The Illusionary Treatment Optionand self-proclaimed \"anti-ice man\", suggests our love affair with ice evolved from one specific incident over a decade earlier. Which is clearly the goal here after all. As with ice, here are some things that need clarification with the RICE method. Anyone that has played sport has heard the term ‘RICE’ – Rest – Ice – Compress – Elevate for the treatment of sporting injuries, such as strains and sprains. The Stages Of Healing an Injury The healing response is a cascade of events that instantly occur post-injury. We learned it in middle school and high school health classes. What we’re trying to achieve with ice almost directly contradicts what the body is trying to do post-injury. Does this principle also apply to chronic inflammation such as arthritic joints? With ice off the table, it’s important to discuss what role, if any, for heat.As it stands there aren’t too many reasons to use heat either. ‘If you immediately ran off … and stuck ice on [an injury], you may actually be delaying your healing process slightly,’ Dr Murray said. But a small shift in perspective clearly shows us that we genuinely need swelling, inflammation, and pain for basic healing. If the Boxer was trying to recover as quickly as possible for their next fight, ice should be avoided. Compression socks and stockings are potentially disadvantageous despite how common they are. Medication may provide temporary relief from pain and discomfort but will ultimately drag out your recovery at the other end. The body knows what it’s doing. The current recommendation for how long to ice an injury is 15-20 minutes every 2-3 hours, for the first 2-3 days. When should I use an ice bath? He was involved in an accident that completely tore his right arm from his body. This way you’ve been able to sleep and optimize recovery whilst still down-regulating the nervous system. Again, we know that swelling is the accumulation of waste at the end of the inflammatory cycle and it needs a clear path out. Want the latest information on how to keep your body injury free, increase your flexibility and reach your fitness goals? Instead, it means there’s a failure to appropriately evacuate the swelling that’s there – so it pools. Ankle Rehab, a healing system developed by Scott Malin, NASM-CPT that focuses on ankle injuries. And on the surface all of this makes sense. The Voodoo Floss bands are fantastic for freeing up glued down tissue, assisting the removal of swelling and re-perfusing damaged tissue all within your limits of pain and mobility. After all, this isn’t a conversation about ice vs nothing. How do I best use an ice pack? A quick look on Amazon shows just how many ice packs, cool packs, ice bags, ice gels and even your own personal cryotherapy machines there are. But this blood flow carries cells that support the inflammatory process needed for healing. 2 This can cause an increase of blood flow to the injury and create more inflammation. From what I see clinically, massage and getting the injured area moving in a respectful manner make all the difference to optimizing healing. Having said that we still need an alternative to ice. But as you can hopefully see by now, it isn’t because of ice, it may actually be despite it. Ice: As we\'ve already mentioned, ice may, in fact, delay almost everything to do with the healing response. Elevation is important to assist in the optimization of waste removal from the injured area. A muscle stimulator can gently tense and relax these muscles for hours. We know what ice does to the body yet this directly contradicts what the body is trying to do when healing. With this in mind, we can finally get a sense of how long injuries should take to heal. We\'ve never really had the need to question this too much because people do get better at the end of the day. Not only does local compression limit the movement of fluid coming into the area but it will also limit the movement of fluid going out as well. Not only may ice fail to speed up the healing process, but it may actually be. The challenge is to find that balance based on your injury. Similarly, conscious deep breathing has the added bonus of being able to down-regulate our nervous which becomes instantly heightened when pain is involved. By heating an injury we run the risk of driving too much fluid to the area. During this process the severed arm was put on ice for preservation, a tourniquet was placed on the area and elevated to restrict further blood loss. Related: Here are over a dozen everyday benefits of the Marc Pro to revolutionize your rehab and recovery. The second situation in which ice application may be beneficial is when you need to perform repeated efforts. Again, ice should no longer have been used once the arm was re-attached and healing became the bigger priority. We see scarring, wound closure and new blood vessel growth as things progress. Now, with our advanced understanding of the effects of ice on injured tissue, it’s at least a little clearer. This is Grant. How long should I ice an injury? Perhaps the next morning instead. One of the by-products of this initial inflammatory reaction is swelling. Technically there is no such thing as \"too much\" swelling, just the amount your body deems appropriate given the circumstances. If we are very clear on the reasons why we ice an injury, yet those reasons contradict what needs to happen for the injury to heal, why is ice so popular? Dr. Gabe Mirkin Changed His Mind Perhaps the most compelling reason to stop following the RICE protocol comes from Dr. Gabe Mirkin himself. Contact Us … They are not the norm. Why you shouldn’t self-diagnose your injuries. So much so, it may be time to reconsider using ice to treat your sprain or strain. Ice does decrease your ability to feel pain. Mainly because it really doesn’t feel we need to. The harsh reality is that as soon as we remove the ice and the tissue re-heats, the inflammatory process continues anyway. For this reason you should always consult a Physio in this first 24-48 hours following an injury. By avoiding ice, we can see injuries that typically take a month, settle in as little as a few weeks. But don’t take my word for this, let’s discuss why you should consider giving ice the cold shoulder as well. It may contribute to greater swelling and increase local tissue death despite being an effective pain reliever. We all know icing and heating are two of the most common and natural treatment options available. In fact, when you take a step back we run into two major issues: What we\'re trying to achieve with ice almost directly contradicts what the body is trying to do post-injury.Not only may ice fail to speed up the healing process, but it may actually be slowing it down. Usually, the answer comes back to the ice of ice, and a lack of adequate movement. With this in mind, we can finally get a sense of how long injuries should take to heal. “Everyone knows” that you ice a sprained ankle. All it took was becoming aware of and removing an unnecessary handbrake I didn\'t know existed. An ice bath has a fantastic ability to engage the Parasympathetic nervous system. To see how I can help you  BOOK ONLINE TODAY, Monday 6am–8pm Tuesday 6am–9pm Wednesday 6am–8pm Thursday 6am–9pm Friday 6am–3pm Saturday 8am–5pm Sunday 9am–2pm, Treatment Options for Sacroiliac Joint Dysfunction (SIJ). Swelling Much like putting a tube of toothpaste in the freezer, ice makes congestion harder to remove. As with ice, there are situations where subduing pain and inflammation can help. At this point, it is vitally important to be clear. DOMs or delayed onset of muscle soreness is a label for next day discomfort after exercise. Local nerve endings become sensitized thanks to the brain’s perception of threat and the compression of the injured issue by swelling. Some feel massage isn\'t appropriate for an injured area. Categories: November 06, 2014 . Not because it isn\'t true, but because it challenges decades of rusted-on thinking in an industry of rusted-on thinkers. Going back a little further, Gary Reinl, author of Iced: The Illusionary Treatment Option and self-proclaimed “anti-ice man”, suggests our love affair with ice evolved from one specific incident over a decade earlier. But don\'t take my word for this, let\'s discuss why you should consider giving ice the cold shoulder as well. We also know this system is completely passive. During this process the severed arm was put on ice for preservation, a tourniquet was placed on the area and elevated to restrict further blood loss. 5. Thank-you for articulating it so well. This shift in thinking makes perfect sense to me, but more importantly, my patients are recovering faster than ever before. We need pain and inflammation for optimal healing. There are times when ice can be used effectively, but these are special circumstances where optimizing and preserving immediate short-term function takes priority. Once the fight is over, the role of ice would diminish. So much so, that without something like inflammation there is no healing at all. Our cells need blood flow to survive and it’s well known how ischemia (reduced blood flow) can create accidental cell death. It appeared in his best-selling Sportsmedicine book way back in 1978. In specific moments when icing an injury is appropriate (see above), it\'s best to wrap your ice pack in a damp cloth or towel. In fact, when you take a step back we run into two major issues: And if you consider we often ice because it’s either something we’ve always done or something we feel we should do it may be time to re-think the need for it entirely. Your Wellness Nerd uses real-world conversations to provide a unique perspective on Physiotherapy, Health and Wellness. The first phase traditionally takes a week depending on the injury and how well we manage it initially. We know ice reduces blood flow, so it\'s much harder for those cells to receive that literal lifeblood if we\'re delivering less life-giving blood. We double down on ways to limit the removal of swelling. We know ice reduces blood flow, so it’s much harder for those cells to receive that literal lifeblood if we’re delivering less life-giving blood. While swelling indicates an increased fluid or blood deposits in the area, it slows down recovery from the injury as the swelling from fluid makes joints stiffer and more painful, which in turn makes them weaker. Thankfully there are many effective options to choose from. Perhaps the next morning instead. Dr. Mirkin, who as you may recall coined the RICE acronym in the first place, has publicly changed his mind. And when you look at what ice does and compare it to what needs to happen, it may, in fact, slow down tissue healing not speed it up. I\'ve seen such a dramatic reduction in recovery time across the board. This can be anywhere from 30 seconds to 3 minutes and above depending on the person. Despite what many think, swelling is neither good or bad. Listen to this ... but as long as they do not have an injury, a couple of weeks of rest, ice and anti-inflammatory medication may do the trick. After literally a few seconds you may start to feel the area pulse. Here\'s what happens to the healing process when you ice an injury: Inflammation We know ice restricts blood flow. To highlight why ice may no longer have a role in acute injury management, let’s look at what actually happens to the body during the healing process. Have you ever stood with your arm up in the air for a few minutes? We’ve long thought that ice does speed up healing by limiting swelling and inflammation. Our cells need blood flow to survive and it\'s well known how ischemia (reduced blood flow) can create accidental cell death. You don\'t have to be a hero. However, current research suggests that ice and complete rest may delay healing instead of helping. Massage also has the secondary benefit of reducing pain. Now, with our advanced understanding of the effects of ice on injured tissue, it\'s at least a little clearer. Having said that we still need an alternative to ice. It’s important to note I have no affiliation with the brand itself, I’m just a fan of what short intervals of compressed flossing can do. Make sure you join our monthly newsletter below for our tips on how to lead a healthy life. Think of sending all that new oxygen to the damaged tissue to help the repair. You don’t have to be a hero. Even if ice did as advertised, we probably don’t need to use it anymore. Thankfully there are many effective options to choose from. Back in 1978, in The Sports Medicine Book, Dr. Gabe Mirkin coined the term RICE (Rest, Ice, Compression, Elevation). One of the by-products of this initial inflammatory reaction is swelling. Elevation: Elevation makes sense, but it also doesn\'t. Click for more information on Voodoo Floss bands The idea here is to wrap up the injured area so it\'s comfortably tight. R.I.C.E stands for rest, ice, compression and elevation and is used post-injury in the hope of promoting faster healing and return to sport. R.I.C.E stands for rest, ice, compression and elevation and is used post-injury in the hope of promoting faster healing and return to sport. I’m not a martyr to the cause. We can optimize swelling removal with other techniques that don’t come with side-effects. However, regardless of whether ice can or cannot reduce inflammation may be irrelevant as we now know that the inflammatory process is a necessary and crucial component of proper healing. It\'s just the build-up of waste yet to be evacuated from the area. And that massage and motion are the way to go. Thankfully there are far more effective replacement options. Perhaps the most compelling reason to stop following the RICE protocol comes from Dr. Gabe Mirkin himself. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Since then, icing has been the standard treatment for injuries and sore muscles due to its ability to relieve pain immediately in a cost-effective manner. But an ice bath has the same negative effects on our tissue as an ice pack. It makes sense to apply ice for something like a nasty cut above your eye. I’ve seen such a dramatic reduction in recovery time across the board. It uses strong elastic compression and respectful pain-free movement to facilitate faster recovery. However, current research suggests that ice and complete rest may delay healing instead of helping. It\'s also part of most post-surgical protocols and the foundation of every first aid course. Not only does local compression limit the movement of fluid coming into the area but it will also limit the movement of fluid going out as well. https://www.podiumrunner.com/.../shouldnt-stretch-before-run One that happens each and every time damage occurs. ... stopped me putting on 200-500 grams in weight post exercise which was probably the waste lymph being stuck where it shouldn’t have been. However, these processes are actually needed for healing to occur. Usually, the answer comes back to the ice of ice, and a lack of adequate movement. Why you Shouldn’t Ice an Injury. The boy was also told to remain calm and rest - the very foundations of today\'s RICE protocol. Frequently Asked Questions What does the RICE acronym stand for? Should I use ice or heat for an injury? Mainly because it really doesn\'t feel we need to. Compressing these vessels doesn\'t facilitate this. We see scarring, wound closure and new blood vessel growth as things progress. This allows for better cold transference. So much so this conversation is almost moot anyway. This again relates back to pain management, allowing the player to continue playing in the case of muscle soreness or minor injury. Icing for temporary pain relief makes it difficult to know what is OK to do and how much is too much. In an article published on his website back in 2015, Dr. Mirkin outlined his change of heart-based on new insights and a broader perspective. As a result, we need movement to best clear swelling, not immobility and general surface compression. Why ice doesn't help an injury and could even make it worse In other words, we have to enter the tunnel at the inflamed, swollen stage in order to successfully exit at the healing stage. While certainly not ideal and most likely counterproductive, ice should not be demonized. The accepted treatment of icing your injury that has been in place for well over five decades has come into question. ", "UK English Female", ["buttontext=\"Listen"]); There was clearly a more pressing need. Clearly too much movement has to potential to be just as disadvantageous as too little, but do what you can as soon as you can. The MARC Pro Another game-changing piece of rehab equipment is a muscle stimulation machine - the most notable of which is the MARC Pro. These cells facilitate the repair and/or removal of damaged tissue. Why It\'s Wrong to Ice an Injury In everyone\'s defense, using ice to effect swelling, inflammation, and pain does make sense on some level - particularly if we see them as bad. For what it’s worth I used to be an advocate for icing an injury just like everyone else. As of today he no longer recommends the use of ice for injury, and neither should you. Instead, it means there\'s a failure to appropriately evacuate the swelling that\'s there - so it pools. Breaking up the ice will also help it conform to the injured area. Otherwise, we’ll see increased swelling and delayed progression of healing.A heat pack is fantastic to help loosen stiff, tight and generally dysfunctional areas. Compression may not be the most effective way to overcome swelling as it restricts the flow of both the 'in' and 'out' vessels. But our physiology tells us something different. The negating effects of compression become even more profound when we add rest into the equation. The thing I see missing is one of the biggest reasons why you should ice after an injury… Leading Doctor Changes Tune, Says You Shouldn't Ice Injuries or … This allows you to perform rehabilitation exercises and mobile the injured area, which has a secondary benefit of reducing swelling. Interestingly, the pain, swelling, and inflammation we try so hard to prevent or reduce with ice are integral to the body’s natural healing response. Until recently, this was the topic of good debate. Is ice appropriate for DOMs? Take 30-40 deep breaths (as per Wim’s breathing protocol) and supercharge your body with oxygen. If there\'s more swelling than expected, perhaps it\'s better to ask why the swelling is not being removed as effectively as it should be. We elevate to help the removal of swelling, but it also makes it hard for blood to flow where it\'s needed. After taking your final breath in, breathe fully out and stay there until you feel ready to breathe in again. Things That Can Effect the Healing Process Although an automatic response there are things that negatively affect the healing process: infectionmore traumaagenutritionhydrationpoor sleepchronic stressother diseases like Diabetes etcanti-inflammatory drugs So with all this in mind, it raises a very important question. After all, this isn\'t a conversation about ice vs nothing. The idea here is to wrap up the injured area so it’s comfortably tight. Using ice to treat injury is similar to pressing pause on the healing process, thus actually making it take longer than it should. We want to be right up against your comfortable threshold for movement without encroaching on pain. How to Best Facilitate Healing and Recovery Without Ice (and RICE), completely tore his right arm from his body, an article published on his website back in 2015, what else it can do for my patients and I, What is Fibromyalgia: A Fresh Perspective on a Very Real Condition, The Cause of Knee Pain: Why It’s a Consequence of Something Else, 11 Physical Signs the Modern World Is Taking Its Toll (And How to Fight Back), Why the True Cause of Hamstring Injury is Back Dysfunction: (ft. Cyril Rioli), Research: Find Better Health and Wellbeing With a Small Dose of Nature, Are Your Headaches Neck-Related? It’s not bad, it’s just not ideal. By heating an injury we run the risk of driving too much fluid to the area. You may do additional damage if you go too aggressive (too tight, too much movement, done for too long) but common sense should help you avoid these issues. I\'m rapt with the results I\'m seeing. Do what you feel you can responsibly. Is icing bad? https://squatuniversity.com/2020/03/23/dont-ice-walk-it-off We also need to appropriately evacuate any waste as well. Before we can challenge decades of traditional ice-related thinking, we need to appreciate why we do it – and have done it for so long. Interestingly heat may be useful for chronic swelling, but as always, movement trumps all in the ice vs heat debate.

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