What’s the first thing you do when you get hurt? Like say you fall, sprain your ankle, hurt your knee, arm or elbow? You ice up, right? This is almost everyone’s first aid SOP when anyone gets hurt. “Need me to get some ice?”, “I can go get a bag of ice”, “Should we ice this up?”. Now essentially, what does this really do? We do it to bring down the swelling or lessen the pain, sure if you wanna get numb, that’ll work.. but apparently icing only delays the swelling, so really it will swell anyway. Why is this? There are 3 phases in the process of healing, and Number 1 is swelling.
Let’s turn to the experts at:
Here goes. You should stop icing. We were wrong. I know. I’ve even been guilty of advocated for short icing stints on this blog. I was wrong. For the past year, I’ve been engaged in a personal moral debate about icing that in retrospect, seems silly if not out right obvious. We should not ice. For the last year, I’ve advocated for no icing with every athlete with whom I’ve helped either post-surgery or post-injury. The outcomes have been nothing short of stunning. Even way back in Episode 204, “Donnie Thompson, Strongest Powerlifter Ever, Cares About Your Swelling,” (15 months ago) we started shifting our management of swelling chiefly to compression. And that was before I met Gary Reinl of Marc Pro. Every athlete worth his or her salt knows of the old RICE acronym. And dammit if I wasn’t already hearing and experimenting with reduced icing protocols for the last few years (remember numb and done?). My problem with NOT icing, I told myself was that I didn’t have other good tools on hand to minimize the pain of swelling (which is the real athlete problem eh?). As it turned out, the solutions presented themselves (excellent compression apparel, Dick Hartzell’s compression protocol, and the Marc Pro) at the same time that common sense matched up with my own clinical experience and test/retest ethic. Maybe it was because I finally felt like I had other mechanisms with which to deal with the swelling, that I could resolve the dissonance I had around this outdated modality. Don’t get me wrong, if you need to make something numb, ice is great. As Mr. Reinl points out, “Yes, (making something numb is good) if the short-term goal is pain control and the prevention of the body’s normal cellular and vascular response to injury.”
Let me quote Dr. Nick DiNubile, Editor in Chief of The Physician And Sports Medicine Journal (physsportsmed.com) “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”
Well what does the research and literature say?
“When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ‘dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ‘in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.” The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986
Top 3 Reasons People Believe We Use Ice for Injury Treatment
- to prevent inflammation;
- to reduce swelling; or
- to control pain.
If the above answers seem reasonable and make sense to you, you need to read the following (now!). If those answers do not seem reasonable and do not make sense to you: congratulations on already being a member of the élite group of informed people on this topic.
Why do I say this? Well, since inflammation is phase-one of the life-saving three-phase healing process (e.g. inflammation, repair, and remodel), clearly you would not want to prevent it. But, regardless, icing damaged tissue does not prevent inflammation, it just delays it. Indeed, fortunately for the icers out there, the tissue just rewarms once their meddling is complete and the process resumes.
SO WHAT SHOULD WE DO?
Here’s some advice from https://www.mobilitywod.com/propreview/people-weve-got-to-stop-icing-injuries-we-were-wrong-sooo-wrong-community-video/
Here is the interview with the inflammation slayer, Gary Reinl, from the recent Crossfit Games. Be prepared to have your mind blown.
So let’s come up with our own new acronym and replace the old, broken RICE model.
Here is the MWod take: MCE
Move safely when you can, what you can. Compress lymphatics and soft tissues (use bands, muscle contraction, clothing, normatec, etc.) Elevate when you can. MCE.
Rest really doesn’t make sense (Don’t flex your broken bone, duh. But do figure out a way to evacuate the swelling left over from the inflammatory cycle.) Ice? No thanks.
Ps. My success and experience with the Marc Pro technology was so profound that we talked the company into donating a unit to our wounded warrior brothers and sisters for every six units our community purchased. If you are interested in this program, please email Troy Willis, firstname.lastname@example.org. During your check out at Marc Pro, use the code “Kstar” and you will receive a small discount and have your purchase counted toward our wounded warriors.
pps. Gary, thanks.
Here is a free video showing how to use Voodoo Floss compression to treat injuries.