I’ve never quite understood the rationale, or obession we seem to have, behind icing an injury. From what I hear the theory is reduce inflammation and swelling, which will then help the injury heal faster. However, if the body is generating all this inflammation and swelling immediately after an injury, maybe it is a necessity? Maybe it’s to the body’s benefit?
I have a hard time believing evolution is so inefficient that after a typical ankle sprain the body has evolved to generate a response so undesirable we need to manufacture the complete opposite response.
In fact, in a lot of injuries, such as tendon or ligament injuries, many rehab programs are designed to increase blood flow to the injured site. Yet somehow we are also constantly bombarding the injured site with ice to “decrease inflammation and swelling?”
If you look into cryotherapy enough in the research world you will find a couple of traits:
1) There are a lot of really crappy studies done, which all say previous studies are really crappy.
2) Ice is consistently found to decrease pain after an injury.
In reference to 1): A lot of studies done on ice/cryotherapy are not well controlled. For instance, one study looking into ice had a control group but the experimental group that experienced benefits used ice and compression. So you can’t derive which one gave the benefit. Furthermore, you can’t have a placebo group when it comes to conducting an ice study. (If you’re using / not using ice, you know it.)
In reference to 2): Giving people Vicodin also decreases their pain…that doesn’t mean it improves their return to activity or helps their injury heal. And in terms of helping the injury heal there isn’t much, if any, evidence justifying the use of ice. Again, the studies aren’t the greatest, but with what we have they don’t say much in favor of ice.
First, from
“For functional capacity, reconvalescence time, work absenteeism and pain relief, no significant differences between the intervention and control group were found. “
Second, from
–Does Cryotherapy Improve Outcomes With Soft Tissue Injury?
“Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth.”
Third, from an “executive” (whatever that means) review of the PRICE (Protect Rest Ice Compress Elevate) treatment for acute injuries:
“There is moderate clinical evidence that cold therapy is effective at decreasing short term pain after acute ankle injury and general soft tissue contusion{…}There is moderate clinical evidence that ice has little effect on other clinical outcomes including recovery time, function, and swelling (limb girth).”
Link:
Lastly, from a paragraph on ice in Kendall’s Muscles: Testing and Function, with Posture and Pain:
“There are a number of conditions for which therapeutic cold should not be used. Cold should not be applied to muscles when the following conditions are present: hypertension (due to secondary vasoconstriction) […], vascular impairment (e.g., frostbite or arterioscleroris) […].”
This is something I have never heard before. I’ve asked a couple of people who are involved in physical therapy or medicine and they’ve never heard of it either.
It makes a lot of sense though. In those with hypertension the blood vessels are constricted due to excessive plaque buildup and such. Therefore, there is less room for blood to flow through the vessels, which causes the heart to have to work harder to pump the same amount of blood through, causing high blood pressure. The idea behind icing an injury is to constrict blood vessels to help rid the area of blood / swelling / inflammation.
This is definitely not an area I know much about but I am assuming the idea behind not wanting to ice an injury in a hypertensive person is you don’t want to be much which will constrict the already constricted blood vessels even more. Doing so could potentially further increase the risk of a heart attack or stroke. In fact, at least one study I found shows whole body cryotherapy increases blood pressure. Granted this isn’t the same as localized icing, I think it’s still worth mentioning.
I also think this is significant considering nearly a third of the country has high blood pressure. Lord knows how many are also experiencing pain at any given moment. Pain they are likely using ice to treat.
Conclusion: Icing doesn’t seem to improve outcomes after an injury. It doesn’t seem to have any negative impact either. I’d say go based on you respond to ice. Personally, and from many who I’ve talked to, icing just makes the injured site feel stiff as all hell and is a pain in the ass. I know others that love it though, and feel like they get quite a bit of pain relief out of it.
Unless you have high blood pressure it doesn’t make much difference either way.
Bonnie Bailey
September 28, 2011
I found that icing after recent knee surgery provided little relief from pain or for controlling swelling (Brian’s my witness for “limb girth” on this one). It was very frustrating that icing was recommended as part of my surgical recovery and yet it had such little impact in helping control pain in the first week. As for the swelling, I’m inclined to agree with Brian that the body just needs to do what it’s going to do to recover. Interesting post info though….:) Bonnie
reddyb
September 28, 2011
Thanks for input Bonnie :).
Sarah Merten
October 1, 2011
So you’re saying ice is a personal choice, though not recommended for those with hypertension. Huh. Ok, so basially see how you feel after icing an injury. What are some things that CAN be done and ARE beneficial? Let’s use a strained hamstring muscle as an example. Compression? Ice as needed? Rest?
reddyb
October 4, 2011
When it comes to alleviating a strained muscle you need to first determine what the cause of the strain is. For example, as I wrote in “Just cause it feels tight, doesn’t mean it is ( http://b-reddy.org/2011/07/21/just-because-it-feels-tight-doesnt-mean-it-is/ ) I used an example of the upper traps being chronically lengthened. This is poignant because in some muscle strains the strain is due to a sudden over stretching of the muscle. But in the case of the upper trap in that post the muscle is strained, but it is due to a chronic over stretching. In the case of a chronic overstretched muscle the solution is to help shorten the muscle (such as plop the arms up in the upper trap example) and to strengthen the hell out of the muscle, also helping to tighten it up.
In other cases, often in hamstring strains, the strain is due to an underactive synergist. This means another muscle that performs similar actions to the strained muscle is not performing optimally. Bridging this to a hamstring strain, the hamstrings help to extend the hip and flex the knee, and often it is the glutes, also a hip extensor, that are not helping the hamstrings out as well as they could be.
An easier way to think of this is if you have 10 workers doing construction on a house and suddenly 5 workers are out sick, the remaining 5 are going to get pretty pissed off if they have to still perform the work that was expected by all 10. If they do this long enough they become tired, sick, burnt out…in other words, strained.
Get the glutes to fire better; get them stronger, and that helps take off some of the pressure on the hamstrings.
In your case (Sarah is a client for other’s reading this), you walking with your knees constantly caved inward and internally rotated is a sign the glutes are not working well, as the glutes pull the knee outward and laterally rotate the knee. As I mentioned to you…try to stop walking with your knees hyperextended and caved inward so the hamstrings don’t have to constantly due so much work. Unfortunately solutions for these types of things pretty much never consist of “do this exercise” but consist of “do these exercises AND STOP doing this or that in your daily life.” You can’t undo 16 hours of daily life with 1 hour of exercise.
As far as other modalities to help healing I’m really not aware of much. I mentioned in the icing an injury post that there was a study where compression and ice was put on an injury and that helped promote healing better than no modality at all. Since the research on ice seems to say there isn’t much efficacy for ice, one could possibly conclude that the compression is what is helping the healing of the injury. However, just like icing, it’s pretty damn hard to have a control group. That is, it’s very hard to measure the placebo effect. In the end, I’d be surprised if compression did much for helping to promote healing.
In the end it seems to come down to finding out what is causing the strain, spending a few weeks correcting things based on the assessment, and letting the tissues heal on their own time.
Marilynn Capel
November 1, 2011
Brian, I think I get so much relief from ice because I’m only using it for the comfort factor. I don’t think that there is a healing factor at all. I kinow that when I use ice on my shoulder or back when it’s sore, after about 20 min. I can take the ice off and by the next day I’m not sore! I guess each person reacts differently.
reddyb
November 1, 2011
Definitely. That seems to be the one thing it can help out with re: comfort.
Joseph Phillip Danna
June 20, 2018
Wow! I didn’t know about this at all. I know someone who ices metatarsalgia and foot edema. To ice edema doesn’t seem right to me. What do you think?
b-reddy
June 22, 2018
My general response for any icing is “If you feel it helps your pain, alright. Just don’t think it’s doing anything to help heal.”
For anybody chronically icing something, I am more leery of this than most and will push clients on it some more. I liken it to any drug pain killer. You can get reliant on it / think it’s ok to flare something up because “I’ll just ice it” / avoid addressing the true cause of the problem.
You of course don’t have the overdose risk like you do with e.g. opiates, but you can bring out a lot of the dependence issues. I’ve seen the same thing with Advil, which for a longtime was viewed like icing (minimal downside), but is now getting more and more concern for heart issues.
I’m not sure we’ll ever find a big issue with icing, but many who get “addicted” to icing get more extreme with it. Damn near regularly freezing a body area is, I’m almost sure, not good for an area longterm.
Joseph Phillip Danna
June 20, 2018
I have questions about severe surgical adhesions around the knee which prevent knee flexion. Please direct me to anywhere on your site where you might address this. Couldn’t find anything in a search. Thanks for all your great information!
b-reddy
June 22, 2018
Maybe at the following,
https://b-reddy.org/cant-bend-your-knee-heres-what-to-do/
Some insight into hardware,
https://b-reddy.org/on-having-metal-in-your-body-surgical-implants-weather-pains-and-more/