Someone rolls their ankle. Immediately, everyone has the same reaction; “Get some ice on it!” We, as a culture, have been icing injuries since the 1970’s, but has anyone ever stopped to ask ‘why?’
I did. I wrote my doctoral capstone on ice, titled ‘Ice: Misused and Over Prescribed.’ After digging into the history and evidence of icing injuries I found the following; ice is great for numbing pain, slows inflammation (which is an essential part of healing), prolongs injury and recovery, and can cause damage to tissue (though this is quite rare). This means that ice is overused and overprescribed. It should only be used to manage pain or slow biochemical decay (in instances like losing a finger with the possibility of it being reattached). Ice alone should not be used to expedite the healing process.
So where did the application of ice begin? Ice was first documented for acute injury management protocol in Dr. Gabe Mirkin’s best-selling Sports Medicine Book in 1978. RICE, rest ice compression and elevation, became the gold standard treatment for acute injury. However, the very same Dr. Mirkin is now speaking out against the lack of evidence for cold therapy. Read ‘Why Ice Delays Recovery’ by Dr. Mirkin.
To understand how ice delays recovery, let’s first understand the recovery process. There are different models of healing, but the four stage approach of healing will be described here.
1. Hemostasis: blood clotting, which begins at the onset of injury with the objective of stopping immediate blood loss. Clotting factors rush to the site of the injury and form a fibrin mesh.
2. Inflammation: the body sends white blood cells to the area to clear bacteria, debris, and dead or dying tissue. This sets the stage for new growth. This phase usually peaks between 24-48 hours after injury. Interestingly, white blood cells also secrete growth factors and proteins. These attract other immune cells that facilitate tissue repair. The inflammatory phase usually lasts between 4 and 6 days, though this differs based on severity of injury and re-injury.
3. Proliferation: the wound is rebuilt with new tissue. New tissues and networks of blood vessels are built. This stage usually lasts between 4 and 24 days, again depending on severity of the injury and re-injury of the tissue.
4. Maturation or Remodeling: the new tissue regains strength and flexibility. The tissue reorganizes while it matures. The time of this stage varies, again based on severity of injury and re-injury, but also on the health of the individual and any healing modalities used. It can last anywhere from 24 days to 2+ years.
Ice affects each of these stages. Ice is a known vasoconstrictive agent, meaning it constricts blood vessels. This limits the arrival of specialized cells. Ice limits the body’s response by slowing blood flow to the affected area. If applied immediately, ice will limit the available clotting factors from arriving, thus increasing blood loss in the area. If ice is applied during the inflammatory phase, it will slow the arrival of necessary white blood cells that clean the area of bacteria, debris, and dead tissue as well as secrete growth factors that set the stage for phase 3 of healing. Ice applied in the proliferative or remodeling phases will deter the arrival of necessary building blocks for new and maturing tissue.
Ice also congeals fluids. This is especially important for the lymphatic system, which does not have a pump. The lymphatic system maintains fluid levels in our body by removing the fluids that leak out of our blood vessels. It is key to our immune function. Lymph is moved via our respiration and skeletal and smooth muscle contractions. Ice thickens lymph and can cause lymphatic back flow. This principle is addressed in ‘Iced’ by Gary Reinl, renowned in the sports medicine field.
There is no denying ice’s ability to numb pain and soothe inflamed areas, but there is little to no evidence that supports its ability to enhance recovery. In fact, there is more evidence that it slows and deters healing. Ice is misused, it should not be applied to encourage recovery from injury. It is over prescribed by doctors and community members. If you’d like to read more about it, read Dr. Mirkin’s article ‘Why Ice Delays Recovery,’ or ‘RICE: Then End of an Ice Age’ by Joshua Stone.