Why Ice and Anti-inflammatory Medication is NOT the Answer

Icing a sprained ankle In July I posted a blog discussing The Overuse of Cryotherapy. The controversy surrounding the topic made it one of the most popular blogs I’ve written. What is surprising to me is that a controversy exists at all. Why, where, and when did this notion of anti-inflammation start? Ice, compression, elevation and NSAIDs are so commonplace that suggesting otherwise is laughable to most. Enter an Athletic Training Room or Physical Therapy Clinic nearly all clients are receiving some type of anti-inflammatory treatment (ice, compression, massage, NSAIDs, biophysical modalities, etc). I evaluated a client the other day and asked what are you doing currently – “Well, I am taking anti-inflammatories and icing.” Why do you want to get rid of inflammation and swelling? I ask this question for both chronic and acute injury!

The Stigma of Inflammation:

Editor in Chief of The Physician and Sports Medicine Journal (Dr. Nick DiNubile) once posed this question: “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?” Much like a fever increases body temperature to kill off foreign invaders; inflammation is the first physiological process to the repair and remodeling of tissue. Inflammation, repair, and remodel. You cannot have tissue repair or remodeling without inflammation.  In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase (1). Researchers headed by Lan Zhou, MD, PhD, at the Cleveland Clinic, found that in response to acute muscle injury, inflammatory cells within the damaged muscle conduct phagocytosis, contribute to accumulation of intramuscular macrophages, and produce a high-level of Insulin-like growth factor 1, (IGF-1) which is required for muscle regeneration (3). IGF-1 is a primary mediator of the effects of growth hormone and a stimulator of cell growth and proliferation, and a potent inhibitor of programmed cell death. Similarly, in 2010, Cottrell and O’Conner stated “overwhelmingly, NSAIDs inhibit or delay fracture healing” (2). And you want to stop this critical process of healing by applying ice, because inflammation is “bad”?

The Anecdotal Rationale for Ice:

Somewhere along the line the concept that ice facilitates healing became conventional wisdom. Sorry, that wisdom is wrong. I had someone tell me the other day, “We need to ice, because we need to get the swelling out.” Really? Does ice facilitate movement of fluid out of the injured area? No, it does not. The lymphatic system removes swelling. The Textbook of Medical Physiology says it best: “The lymphatic system is a ‘scavenger’ system that removes excess fluid, protein molecules, debris, and other matter from the tissue spaces. When fluid enters the terminal lymphatic capillaries, any motion in the tissues that intermittently compresses the lymphatic capillaries propels the lymph forward through the lymphatic system, eventually emptying the lymph back into the circulation.”  Lymphatic drainage is facilitated by contraction of surrounding muscle and changes in compressive forces that push the fluid back to the cardiovascular system. This is why ankle pumps work so well at removing swelling.

Inflammation is a necessary component in the first phase of phase of the healing process. Swelling is controlled by the body’s internal systems to attain homeostasis. If swelling is accumulated it is not because there is excessive swelling, rather it is because lymphatic drainage is slowed. The thought that ice application increases lymphatic flow to remove debris makes no sense. Gary Reinl, author of “Iced! The Illusionary Treatment option gave me a good analogy. Take two tubes of toothpaste, one is under ice for 20 minutes, the other is warmed to 99 degrees. In which tube will the toothpaste flow fastest?  It does not take an advanced physics degree to know that answer.

What might surprise you is that ice actually reverses lymphatic drainage and pushes fluid back to interstitial space. A study published in 1986 (yes, 1986, is old, but this is a foundational study) found when ice is applied to a body part for a prolonged period of time; lymphatic vessels begin to dramatically increase permeability. As lymphatic permeability increases fluid will pour from the lymphatics into the injured area, increasing the amount of local swelling (5). Ice can increase swelling and retard debris removal!

The Acronym RICE is Bogus:

The acronym RICE is bogus in my opinion. First, Rest is not the answer. Rest does not stimulate tissue repair. In fact rest causes tissue to waste and can cause abnormal gene transcription of collagen tissue. Evidence has shown that tissue loading through exercise or other mechanical means stimulates gene transcription, proteogenesis, and formation of type I collagen fibers (See studies by Karim Khan, Durieux, Mick Joseph, and Craig Denegar). Our body has all types of cells. When a cell is born it has no clue what type of cell it will eventually become. This infancy cell – for lack of a better term – is called a progenitor cell. Progenitor cells can be changed to a specific cell type. Load in tendon tells our body to turn a progenitor cell in to a tenocyte. Load in bone tells a progenitor cell to become an osteocyte. Ever wonder why myositis ossificans (calcification or bone growth in muscle) develops? The direct, repeated trauma turns progenitor cell currently living within muscle to an osteocyte. Subsequently, we develop bone growth within muscle.

The other reason RICE is bogus is obvious; Ice. Ice does nothing to facilitate collagen formation. Ice will not influence progenitor cell development. Ice does not regenerate tissue. Ice does not facilitate healing – it inhibits natural healing process from occurring. Ice does not remove swelling; it increases swelling and lymphatic backflow.

Closing thoughts:

Bottom line, ice and NSAIDs are over utilized. I am not saying never, but I am saying ice is not a magical cure all that fixes everything and is required for healing. It is not the gold standard that it has come to be. My goal with this blog is to get individuals to stop and think before immediately turning to ice and NSAIDs. Is it really the best option? Is it necessary for this injury at this stage? I understand it is not the only form of treatment clinicians use, but ice certainly is the most heavily used. Go ahead, I will wait while you look at your treatment logs.

My goal is to get this trend reversed one clinician and one patient at a time. Have you seen the video discussion between Kelly Starrett, DPT and Gary Reinl? If not I recommend you watch it. It’s fascinating. I am glad to have expert minds like Kelly and Gary in this fight with me.

I ask health care professionals to do one thing, just try it. Pick one client with chronic musculoskeletal pain, skip the ice, skip the NSAIDs and try to use light exercise as a repair stimulus. Then, try skipping the ice on a client with an acute mild injury. The outcomes might surprise you. Great Thought Provoking Reads

  • NATA 2013 Meeting. **If you have access – read these**
    • Selkow, NM, Pritchard, K.  CRYOTHERAPY FOR THE 21ST  CENTURY: UPDATED RECOMMENDATIONS, TECHNIQUES, AND OUTCOMES. NATA 2013 Annual Meeting.
    • Dolan. New Concepts in the Management of Acute Musculoskeletal Injury. NATA 2013 Annual Meeting.
    • Johnson, M, Denegar, C. Mechanobiology, Cell Differentiation and Tendinopathy – From Bench to Bedside. NATA 2013 Annual Meeting.
  • Articles and Peer-Reviewed Literature
    • William JR, Srikantaiah S, Mani R. Cryotherapy for acute non-specific neck pain (Protocol). Cochrane Database of Systematic Reviews 2013, Issue 8.
    • Block, JE. Cold and Compression in the Management of Musculoskeletal Injuries and Orthopedic Operative Procedures: A Narrative Review. Open Access Journal of Sports Medicine 2010:1 105–113
    • Hubbard, TJ, Aronson, SL, Denegar, CR. Does Cryotherapy Hasten Return to Participation? A Systematic Literature Review. J Athl Train. 2004 Jan-Mar; 39(1): 88–94.
    • Bleakley, CM and Davidson, GW. Cryotherapy and inflammation: evidence beyond the cardinal signs. Physical Therapy Reviews. Volume 15, Number 6, December 2010 , pp. 430-435(6).
    • Bleakley CM, Glasgow P, Webb MJ. Cooling an acute muscle injury: can basic scientific theory translate into the clinical setting? Br J Sports Med. 2012 Mar;46(4):296-8.
    • Hart JM, Kuenze CM, Pietrosimone BG, Ingersoll CD. Quadriceps function in anterior cruciate ligament-deficient knees exercising with transcutaneous electrical nerve stimulation and cryotherapy: a randomized controlled study. Clin Rehabil. 2012 Nov;26(11):974-81.
    • Hubbard, TJ, Denegar, CR. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? J Athl Train. 2004 Jan-Mar; 39(1): 88–94.
    • Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261.
    • Takagi, R, et al. Influence of Icing on Muscle Regeneration After Crush Injury to Skeletal Muscles in Rats. J of App Phys. February 1, 2011 vol. 110 no. 2 382-388

**Update**:  I’ve had an enormous amount of feedback for this post. I greatly appreciate all of it – good and bad. I am adding this note in regards to an overwhelming amount of questions / comments about acute injury.  My response is yes, in many cases I would skip the ice for acute injuries as well!! What is the benefit to delaying the healing process? Some will say, “to prevent hypoxic death” or “to reduce pain”. There are other ways we can stop hypoxic tissue death that do not stop healing.  I agree ice has pain modulating effects. But to this I ask, at what cost are we reducing the pain? Is a temporary (30 minutes) pain reduction more important than healing? References

  1. Buckwalter, JA, and  Grodzinsky, AJ.  Loading of Healing  one, Fibrous Tissue, and Muscle: Implications for Orthopedic Practice. Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999.
  2. Cottrell, and O’Connor, P. Effect of Non-Steroidal Anti-Inflammatory Drugs on Bone Healing. Pharmaceuticals, Vol 3, No 5, 2010.
  3. Haiyan Lu, Danping Huang, Noah Saederup, Israel F. Charo, Richard M. Ransohoff and Lan Zhou. Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. The FASEB Journal. Vol. 25 no. 1 January 2011. 358-369.
  4. Guyton, AC and Hall, JE.  Textbook of Medical Physiology 10th Ed., W. B. Saunders Company. 2000.
  5. Meeusen, R. The use of Cryotherapy in Sports Injuries. Sports Medicine.  Vol. 3. pp. 398-414, 1986.

 

365 thoughts on “Why Ice and Anti-inflammatory Medication is NOT the Answer

  1. Pingback: Icing injuries - Why I am anti-ice

      1. Carol Koenigsknecht

        If the body is not doing its job efficiently, what would you recommend aside from light exercise? I would think herbs and foods that help stimulate the lymphatic system would be in order. Also herbs and foods that support healing. And would heat also be as detrimental as ice?

        Reply
    1. toni

      No its hot shower that causes vasodilation and sets the blood in motion and promote circulation. You are actually making the blood vessel vasoconstrict when your taking a cold shower.

      Reply
  2. Adrian W.

    Or at least alternating temperatures – hot and cold. But since the inflammatory area is already warmer than usual, what harm can a bit of cold do? Isn`t it alternating temperatures?

    Reply
  3. Joel Blackburn

    I’m not sure the researche is definitive. You bring up some good points, however. But, I think that more research needs to be done on the types of injuries, the amount of swelling, and the type and amount of inflammation. For example, a crush injury of the foot can cause compartment syndrome. So, this is an example of a certain amount of inflammation and swelling which is bad and can cause amputation and loss of the foot. Therefore I think that swelling and inflammation is a continuum. Just like a fever, some fever can be good but too much is bad. Therefore, let’s not throw out the baby with the bath water just yet. Our cavemen ancestors didn’t have ice or antibiotics. We have both. Therefore, I think that we need to use science to figure out when to use ice and when not to use it.

    Reply
    1. Joshua Stone Post author

      Thanks, Joel.
      You are correct, the research is not yet definitive, which makes my point about icing. Why are we icing so much, if the evidence is not definitive?

      Reply
      1. Chad Nowlin

        Really the evidence is quite clear. Most people are just looking for it in the wrong places. Look at all the research on the lymphatic system. The evidence is clear that muscle pump action in the extremities, and large vessel pulsation in the torso are what moves and removes swelling from the tissue spaces. Ice does not make muscles contract or increase large vessel pulsations… it actually does the opposite. Countless studies on the healing process show that when tissue damage takes places the same 4 stages take place to heal the tissue: 1. rapid hemostasis, 2. inflammation, 3. repair, 4. remodel, and these steps do overlap but occur in that order. Essentially the body is closing off damaged vessel and growing new ones to bring in nutrition and carry out damaged cells, inflammation brings in these worker cells and triggers the cascade to begin the repair process. Ice has been shown to slow angiogenesis and the arrival of inflammatory cytokines that draw in the cells responsible for repair.

        In short:
        We know muscle action is the mover of the lymphatic system
        We know ice does not pump muscles, which means it can not move swelling.
        We also know the healing process, which requires inflammation
        —you can have inflammation without healing, but you can not have healing without inflammation.
        We know ice slows inflammation…which stands to reason- slows the healing process.

        Best case scenario: when you use ice you are delaying the healing process and not doing anything to actually address the swelling that is already present in the joint. As soon as the body regains normal temperature the inflammatory process gains. All you have done is slow it down for 20 minutes and created a stagnant joint full of swelling and toxic garbage.

        Reply
        1. Joel Blackburn

          I’m a physician and athlete. I’ve had injuries and surgery. To say ice is never good is a far stretch.

          Reply
      2. Doug Long

        Would kinesiotape for edema control with range of motion in the pain free range be a better acute treatment?

        Reply
  4. Mike

    My rationale for ice for so long was to decrease hypoxic death and secondary metabolic injury. You mention that there are other ways to do this that do not involve ice, could you please share an example? Thanks!!

    Reply
    1. Joshua Stone Post author

      I’ve heard this hypoxic question a lot. Hypoxia is not because of excessive swelling it’s because swelling does not leave the area.
      Instead of preventing swelling use light massage, compression, or movement to facilitate lymphatic drainage and remove swelling. Ice slows and reverses lymphatic drainage.

      Reply
  5. Ralph

    Remember the anti-icing discussion is more directed at soft tissue injury and perhaps fx healing. (If I recall correctly Dr. Mirkin’s apology to the training community was directed toward soft tissue injury) I should think arthritic conditions would warrant icing. OA in particular. What could be healing here? The ongoing disease process advances more quickly with a warmer environment, yet function is often improved with exercise but the needed exercise is limited by pain. Ice limits the pain, thereby allowing for exercise, and reduces what are essentially exuberant healing effects of the disease process.

    Reply
  6. Greg Bryson

    As a practitioner of Chinese Medicine, I’m in agreement that ice is probably overused. It’s refreshing to see articles like this that validate our disdain for ice. Chinese Medicine has long recognized that cold contracts and slows, the opposite of what you want when dealing with injury. Instead of ice, Chinese medicine employs herbs, acupuncture, and manual therapy to reduce swelling. The herbal formula is often changed depending to fit the stage of the injury. I’ve never seen ice work as effectively to clear swelling and bruising. Regarding heat application, CM supplies infrared with moxibustion, but often only after the initial swelling and inflammation have subsided.

    I view swelling as the body’s means of splinting an injury. In times before splints and casts, it would have reduced mobility to prevent further injury. However, I can’t imagine that swelling doesn’t reduce the flow of fresh blood and nutrients to the injury site. That’s the rationale behind clearing it with herbs. The injured person, however, should have enough sense and patience to allow the area to fully heal before returning to full use.

    One possible strike against ice I didn’t see mentioned in the article is the effect of icing on solubility. The founder of my kung fu association proposed that icing could reduce local tissue temperature sufficiently to cause dissolved substances in the blood and lymph to drop out of solution. This would impede healing and circulation by increasing the accumulation of debris. I’m not sure if that has ever been tested, but the idea seemed reasonable to me.

    One last thought…. Cold is also seen as penetrating deeply to the bone. And, as archaic as the theories might sound to some, icing is the best way to make sure your knee injury is aggravated by cold weather later in life.

    Reply
  7. Mark T Brinson

    Very short sighted and irresponsible article that shows little knowledge of how ice fits into the overall treatment approach of the patient.
    worse- basic student will believe this article as I proliferates through the internet..
    Irresponsible and potentially dangerous.
    I guess it keeps people coming into the clinic *facepalm*

    Reply
    1. Joshua Stone Post author

      I appreciate your comment, Dr. Brinson. I do not think it is irresponsible, nor short-sighted. I stand by what I found in literature and practice. This is also not a clientele driver. I see maybe one client / week as it is not my primary job, nor a goal. I do this for passion.

      I am slightly surprised regarding your stance on cryotherapy, however. While many (from western medicine disciplines disagree) you are the very first with training in traditional chinese medicine and acupuncture to disagree. Every LAc I have come across has agreed that we have an over dependency on ice and fail to recognize the importance of inflammation. To each his own. Cheers

      Reply
  8. Mauro

    Next time you sprain your ankle real bad please let me know how NOT icing works for you. You poohpooh icing although in the same breath you agree it has pain modulating effects ??? . Could you please enlighten us on what to do . I read these articles saying what’s bad or doesn’t work and ten you give NO alternatives??

    Reply
    1. Joshua Stone Post author

      Glad you asked, Mauro. In Spetember this past year, I rolled my ankle playing basketball. I would say it was a grade 2 sprain. My ankle was massive! For the first 24-48 hours I was very conservative. I stayed off of my feet as much as possible. When given the chance my leg was elevated to facilitate lympthaic flow and prevent pooling. Around 24 hours, I began effleurage massage from the toes to the knee. I did this a lot (about 4x / day) for nearly two weeks. At 72 hours (maybe a little after) I began light isometrics. Each exercises session followed with elevation and massage. Around the 4 or 5 day mark I began light active ROM (PF and DF only). On day 7 I began doing static gastroc stretches and added friction massage and graston. Slowly I progressed to multiplanar movement, proprioception, strengthening and continued massage.
      I was actually playing hoops about 10 days after the injury. I still had some bruising still in the area, but the ankle was back to about normal size. After a period of 2-3 weeks I was functional and didn’t notice any limitations.
      Not once did I use ice or static compression. Does, ice have pain relieving effects, yes. But, did I writhe in pain and roll on the floor saying “Please somebody get me some ice to reduce my pain!!!” Nope, that didn’t happen. I did take Tylenol the first two nights, because that sucker throbbed. Tylenol provided me pain relief through the night and didn’t require me to fuss with an ice bag. Whereas ice would have provided me 20 minutes of pain relief.

      Reply
  9. Alyson

    What a great ‘food for thought’ topic. I just suffered multiple fractures to the pelvis and in order to get off narcotics just started taking IBU thinking that’s what I needed. It wasn’t until I researched bone healing that I came across the research. It completely made sense. As for the overuse of ice and compression, you mentioned there is a time and place, I agree. It’s so hard going against the grain in the medical field but thank you for breaching the subject.

    Reply
  10. Stuart Halpern

    In your article they are things I been doing for years and I do believe ice is over use and misuse.
    Just because this is the way it has been done for too many years does not make it correct,
    Also I know its hard to change people minds. With my clients I never recommend ice but once they go for PT ice is almost use at the end at every session. The ice I feel slows down the healing process.

    Hope to hear from you
    Stuart

    Reply
  11. Ellen

    This is all very interesting. When you refer to “muscle pump” or “ankle pump” do you mean just moving the affected muscle or the ankle, in a pumping motion? Sorry, but I’m a recovering ankle fracture patient and the last time I took any science classes was way back in high school. I didn’t ice too much after my fracture, which was a trimal fracture with surgery, of course. Screws and a plate were installed. I started using my ankle as soon as they would let me and didn’t really worry about the swelling.

    Reply
  12. Debbie

    Ice is so good at vasoconstriction, but we get an immediate vasodilation when the ice is removed, countering the benefit the ice was supposed to provide. Blood does not clot well at a low temperature according to the coag cascade, so why use ice at all? Immediate pressure for a time indicated by the severity if the injury and elevation above the level of the heart are the biggies for me.

    Reply
    1. Joel Blackburn

      So, do you disapprove of polar ice packs after ACL reconstruction since nearly every orthopedic surgeon in the country recommends it. We see professional baseball pitchers with their shoulders iced in the dugout. Tough sell. I understand your premise but most of us physicians have to practice evidenced based medicine which requires control studies and validation. You have none so it can’t become standard of care. I recommend you get a sports medicine fellowship program to test it. It would be a great study. Again, I believe in science. If the study validates your theory, I’m on your side. Until them it’s no better than recommending coffee enemas.

      Reply
      1. Joshua Stone Post author

        The baseball community is changing, but old habits die hard. As physicians, you must practice the evidence, which is the problem. Show me the RCTs with >6 PEDro scores that show that ice and ice alone facilitates faster healing.

        Reply
      2. Dr. Chad Nowlin

        To agree with Mr. Stone, his point is that there is no evidence that really supports icing. At best it comes to an inconclusive result. Thus, if you use ice based on “evidence” you are using bad evidence. But here is what we can say without a doubt, and as an ER doc you should be able to respect and understand this easily…because the studies I am about to mention are very conclusive and positive you can find them if you look.

        1. Evidence is conclusive on the healing cascade that three things happen. They overlap but go in order. Appropriate Inflammation, then Proliferation, the Maturation. Thus you must have inflammation for healing. Inflammatory cytokines signal for macrophages and other lymphocytes to clean the environment and also “chemotaxy” cells required for proliferation, which signals for maturation. Without Inflammation, the healing process does not occur. This has been seen in studies on rats where all inflammatory processes were removed and the rats had no healing.
        2. Studies conducted considering the hematological effects of cryotherapy do show that ice reduces inflammation. So if you put those two pieces together its logical to say that if ice slows or delays inflammation, it also slow and delays healing. And considering that appropriate inflammation is what is sent to the area, even if you delay the process with ice, once the body reaches normal temperature the inflammatory process will continue until the needed amount of fluid is in the area.
        3. Studies on lymphatics and how lymph vessels work are conclusive that 2 things move lymph. Those two things are muscle contraction, and large vessel pulsations that parallel lymph vessels. In normal healthy lymph vessels it is a one way systems. Muscles contract and force fluid toward the heart, when the muscle relaxes, the negative pressure draws more fluid into the lymphatic system, and the cycle repeats. Large vessel pulsations in the trunk continue to move the lymph towards the heart in absence of direct muscle contraction. So in knowing that only two things move lymphatics, we cant say that ice does either of those things. Especially considering that basic middle school science taught us that colf fluid has more resistance to flow than hot fluid. Icing decrease muscle contractibility which is a prime mover of lymph, and decrease vessel pulsations, the second mover of lymph.

        So even though “evidence” on icing is inconclusive, and there is no solid study yet to say that icing is not what we thought (even though there have been studies that show that icing increases a local backflow of lymph out of the lymphatics into local tissue space), there is plenty of solid evidence to piece together that says icing is not the answer.

        Reply
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  14. Dale

    Mine is very much a layman’s perspective but as minor sports coaches we were always taught that a major benefit of immediate ICE was to limit accumulation of fluid in the injured area. It was presumed that failure to interfere in fluid accumulation would later inhibit healing by leaving too much for dissipation during healing. This was for on-site response to injury … leaving followup treatment to experts. Comments, please.

    Reply
  15. Lee

    Is icing after a long run bad, then? I’ve heard it can be a good thing as it promotes blood flow to the area when the ice is removed. This isn’t for injury, but is taking 10 minutes of ice after exercise a bad thing? Or, are those 10 wasted minutes of healing?

    Reply
  16. Marc Scudamore

    I frequently roll my ankle on trail runs. Since I’m usually not near help or transportation at the time of injury, if the sprain is not too severe, I will continue running or walking, at a reduced pace, until I get back to my car.

    I have noticed a definite reduction in recovery time for the sprains that I have run or walked on immediately following the injury. Sprains that used to lay me up for a week or two largely resolve in a few days if I maintain movement in the foot immediately following the injury.

    Granted, I’m a study with N = 1, but my results to seem to support Stone’s position.

    Reply
  17. Hudson Moore

    Based on personal experience, an easy run is the best way to recover from my hard runs. It also seems like using compression during long runs reduces soreness and recovery time. I don’t ice, and try to stay away from NSAIDs because of other risks.

    I’ve been testing Extra Tart Cherry juice, and hope it’s doing something. But wonder if it’s just a tasty placebo.

    Thanks for article!

    Reply
  18. Fidel B.

    It would be a massive effort to convince the baseball community to not ice. The first thing that pitchers do after a game is ice their arms.

    Reply
  19. Anthony

    Couple things, one is you said rest was a waste of time, but then said you yourself stayed of your ankle sprain for 2 days. How is rest not good? Second I have used and had GREAT results using the game ready system. So are you saying that it is more the compression? I have had grade two ankle sprains back up and playing in 7-10 days with it. I am not saying your wrong, but haven’t been able to find good research on this issue and everyone I have asked had either not heard of it or didn’t have an opinion. When asked ortho Dr he ask me the question…. ” if ice is bad then why do we keep coming back to it?”

    Reply
    1. Chad

      Since appropriate inflammation is the first step in the healing process, anything that slows or stops inflammation slows or stops the healing process. As far as the game ready goes compression is what is move swelling from the affected joint. Compression is heavily researched and at the very least makes sense for a pressure gradient to push fluid to a low pressure area. As far as ice being used to reduce swelling goes is misunderstood by most. Ice could only reduce swelling by preventing further swelling from entering the joint, but this does come at the cost of delaying the healing process. Ice can in no way reduce swelling that is already in the joint or affected tissue. This is why: the lymphatic system has also been heavily researched and has shown that there are only two things that move swelling out of congested tissue. Those two things are muscle contraction and large vessel pulsations. Muscle contractions and pushes fluid up the lymph vessel, muscle relaxes and negative pressure draws more fluid into the lymph vessel and the cycle continues. Large vessel pulsations in the trunk continue to move fluid towards the heart once it enters the abdominal cavity. Icing does not cause muscle contraction, or increase large vessel pulsations. It actually decreases the muscles ability to contract, and reduces blood flow. And just to make a common sense type point… cold fluid has more resistance to flow that hot fluid, so it doesn’t even makes sense to try and freeze the fluid then move it through a tiny vessel. Hope all that makes sense.

      Reply
  20. Chad

    And to address the Doctor situation… We don’t keep coming back to icing. We just cant seem to move away from it to begin with which is largely because people do not know what else to do. And as a general rule of thumb, Doctors practice based on what they learned in school and what they learn from the Doctors they studied under during internships. They do it because that is what who taught them did, and they do it because it is what they have always done. It is rare to find a doctor who will step back and evaluate a treatment, practice, or concept that has been a staple of medicine for so long. No one wants to be wrong about something they have been doing. If we WANTED to be wrong we would not be very smart.

    Reply

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