Full disclosure: I am not a doctor, physical therapist, or any other kind of licensed medical practitioner. I am simply a Level 1 CrossFit Trainer who spends a lot of time reading and researching everything and anything that relates to athletic performance, including sports injury prevention and recovery. If a more qualified individual is treating you and tells you to do something that conflicts with views I present in this article, feel free to mention my viewpoint, but in the end, you should probably follow their advice.
Whenever you sprain an ankle, bang a shin, or otherwise strain, sprain, bump, or bruise something, conventional wisdom says to apply ice. First aid kits often include ice packs, cold packs of every shape and size can be purchased online, and many popular athletes swear by ice baths after an intense workout. But details on exactly how ice should be used are a little fuzzy. When should you use ice? And how often?
You probably shouldn’t. And not outside of some extreme circumstances or corner cases.
If you just want some tips on what to do instead now that you know not to use ice, go ahead and skip to the end. Otherwise, stick around for a slightly technical explanation of why ice isn’t a great idea.
To be fair to ice, there are a few corner cases where it is genuinely beneficial to use it (such as during organ transplants, for reattaching severed limbs, and to create a nice, cold beverage), but outside of those uses, THERE IS NO PEER-REVIEWED LITERATURE SHOWING ANY POSITIVE BENEFIT TO USING ICE TO PROMOTE HEALING. None. It is not shown to significantly reduce swelling. It is not shown to relieve tired muscles. It is not shown to speed up the healing process in any way. There is plenty of research on ice, but all the results show is a big, whopping nothing if the subjects are lucky, and several cases of frostbite or worse if the subjects are not.
You see, wounds heal in four steps.
- Hemostasis (blood clotting) – The body wants to stop things from getting worse, so it slaps a band-aid on in the form of platelets, whether the wound is internal or external.
- Inflammation – Your body starts cleaning out the junk. White blood cells eat damaged tissue and get it cleared out so the wound is ready for the next step.
- Proliferation (growth of new tissue) – The body starts to move in the pieces to create new tissue and does it’s best to pull the surrounding, good tissue back together.
- Maturation (Remodeling) – Things are rebuilt the way they were meant to be, unneeded repair tissue dies and is carted off, and you often get a cool scar.
Notice that inflammation is a critical part of the healing process. But because it is often painful, people assume that it’s bad and do their best to make it go away. That’s like saying that firefighters are bad because there’s always damage when they show up during a fire. Sure, you can try and stop them from doing their job, but things are going to be a hell of a lot worse without them. Yes, icing an injury does slow blood flow and thus slow inflammation, but the second you get rid of the cold, those white blood cells will be right back, just like any good emergency response team.
Another important component of the healing process is the lymphatic system. This bad boy is responsible for clearing out excess fluids and other metabolic waste which helps limit/eliminate swelling. But unlike the rest of your circulatory system, the lymphatic system doesn’t have a big, muscular pump to keep things moving. It relies on the muscles around it to help clear out the junk. This means that when you prop up your leg and slap on an ice pack, not only are you not helping, but by not moving and slowing the flow of fluids with the cold, you’re actually stopping your lymphatic system from doing it’s job.
Finally, numbing an injured joint and then moving on it is a terrible idea. Pain sucks, but it’s there for a reason. It’s your body saying, “Whatever the hell you’re doing is bad and you should stop.” Icing a sprain and then moving on it is going to stop your body from telling you when the joint is in a bad position, likely leading to an even worse injury than it would have been otherwise.
So you get it, you don’t use ice. But what do you do instead?
Heat, compression, and movement are all great.
Heat, unlike ice, has oodles of research backing up its benefits. Anytime a study has shown that both heat and ice is beneficial, it’s really the heat doing all the work. Using just heat and no ice has been shown in all cases to be equally or more beneficial than alternating the two. Spending an hour in the sauna a few times a week has been shown to slow or even prevent muscle atrophy when you are unable to work out due to injury. Heat helps muscles relax and promotes blood flow to the area, which is great both for injury and for recovery after a brutal WoD. And it feels good.
Compression helps your lymphatic system go to town on all that junk. Voodoo floss is an excellent tool for both warm-ups and for treating sprains, which works by temporarily restricting blood flow and loosening up sliding surface tissue, and then it floods the area with blood when the floss is removed. Compression clothing may also improve recovery, and seems to be the most beneficial when worn post workout to assist with recovery.
And movement, of course, is again going to get that lymphatic system pumpin’. In the case of an injury, move as much as possible without causing pain, both up and downstream of the injury. For example, if you have a sprained ankle, this might mean wiggling the toes and bending the knee. Muscle stimulators, such as a Marc Pro or Compex, are also excellent tools. These devices provide gentle muscle stimulation that can help with injury recovery when more vigorous movement isn’t possible, and it is a great option for long trips when you are stuck in a car for hours and couldn’t really move if you wanted to.
Icing is at it’s best a waste of time, and at it’s worst actively harmful. Switch to heat, compression, and walking it off. Or at least moving as much as possible without causing pain. Spread the word and spread the love!
Stone Athletic Medicine – Here you can find several articles discussing cyotherapy (icing) and anti-inflammatories. Authored by Joshua Stone, a Certified Athletic Trainer (ATC), Strength and Conditioning Specialist (CSCS) and Corrective Exercise Specialist (CES), he presents a thorough and knowledgeable case against using ice for sports-related injuries and recovery. His articles also contain dozens of additional, peer-reviewed studies that you can check out for even more information on the topic.
ICED! – Gary Reinl literally wrote the book about not using ice. WIth 40 years of experience in the sports-medicine field, he is well versed in treatments that work, and those that have little benefit (like ice). He’s spent time in the locker rooms of MLB, NFL, NHL, and NBA working with their athletes and advocating alternatives to ice.
Icing Muscles Information – Gary Reinl is back and teams up with mobility guru Kelly Starret to present an informative and to-the-point case against the use of ice in sports injuries.
Kelly Starret and Gary Reinl Explain the Marc Pro – As you might guess from the title, the super team is back to explain the action and benefits to using an EMS (electric muscle stimulator) device.
Still Using Ice and Ibuprofen for that Injury? Check Yourself! – Dr. Seth Oberst, DPT, SCS, CSCS is a residency-trained physical therapist and strength & conditioning coach who works with collegiate, professional, and Olympic athletes, competitive age-division and Masters athletes, and he also works with powerlifting and CrossFit competitors. His article includes a nice summary of the healing process and how it interacts with ice and anti-inflammatories.
Hypothermic Conditioning for Hypertrophy, Endurance, and Neurogenesis – Dr. Rhonda Patrick’s normal field of study is in the field of nutrition, cancer, and longevity, but through her work with heat she found some benefits for those more interested in mad GAINZ. She has also found that sauna therapy can help slow muscle atrophy during injury recovery.
Bringing Light into Darkness: Effects of Compression Clothing on Performance and Recovery – This article’s main focus is on compression clothing, but it also goes over applying compression in general. This article provides a good, if technical, overview of both the perceived and real benefits of compression in relation to athletic performance.