We Might Want To Re-Think The Ice Pack

I am a life-long athlete and lover of all things physical. My ongoing favorites are yoga, running, and CrossFit. But I have also played basketball, baseball, and rugby. Fortunately my injuries have never extended beyond sprains, bruises, and very sore muscles—except for that broken finger.

No matter what ailed me, ice was always part of the solution. Bags of ice from an athletic trainer and reusable ice packs were as synonymous with sporting activities as the equipment I wore to participate in them. When I coached rugby, my answer to a player’s rolled ankle or other acute injury was the RICE theory, which stands for rest, ice, compression and elevation. And when my kids fall of a chair (they were told not stand on) or run into the coffee table for the umpteenth time, we often reach for the ice pack as well.

But some trainers and physicians are suggesting we actually stop icing our injuries.

A recent article in Men’s Health reports that Harvard physician Dr. Gabe Mirkin, the man who coined the term RICE, is now saying that ice may not be best for our bodies after injury. “My RICE guidelines have been used for decades, but new research shows rest and ice actually delay healing and recovery,” Mirkin, now 84, said in the article.

When Mirkin coined the phrase in 1978 he says that his recommendations were based on other doctors’ anecdotal evidence and not extended researched. Even Mirkin agrees that ice is a cheap and easy way to relieve pain and swelling, but his stance has shifted about its effectiveness for the body’s recovery. One of the key components in the healing process after an injury or surgery is inflammation. The next steps are repair then remodeling.

A study published in the Federation of American Societies for Experimental Biology Journal showed that when the body is injured it tries to heal itself by sending white blood cells to the afflicted area. Those white blood cells produce the protein insulin-like growth factor 1 (IFG-1), which is needed for muscle repair and regeneration. The study showed that by icing, we are blocking inflammation, restricting blood flow to the area, and delaying healing by preventing the release of IGF-1.

Exercise-created muscle damage through overuse or strenuous movements can be made worse by ice for this reason and when left on for too long, ice can cause frostbite, nerve damage, and burns. Carefully monitoring time on and off with a layer between the ice and the skin will minimize these particular risks, but even when icing is done safely it could have a negative impact on the body’s ability to heal.

Ice has helped me get swollen, sprained ankles into compression socks so I could put on sneakers by reducing swelling around my ankle. I have witnessed friends recover from ACL or MCL knee surgery with the help of a cryo cuff, which is a sleeve that circulates cold water around the surgical site. And it’s stopped my kids’ crying long enough to find out how they hurt themselves in the first place.

If not ice, what helps?

Instead of icing, several athletes and surgery patients are using electrostim therapy to electrically stimulate the muscles. Patients have been able to achieve muscle control and range of motion without pain or swelling. Others swear by exercise physiologist John Paul Catanzaro’s METH approach to healing. (I know—not the best name.) This stands for movement, elevation, traction, and heat.

Now electrostim therapy isn’t an option for everyone — and I’m certainly not doing that any time my kid has a minor injury — but I do swear by the “motion is lotion” approach to minor injuries and sore muscles. The body moves excess fluid (swelling) from tissue by flushing it out through the lymphatic system, and that system relies on muscle activation. Your body needs to move to move the enlarged blood vessels—a byproduct of inflammation—away from the injured area.

“With an acute injury, you want to get the good stuff in and the bad stuff out. The only way to do that is through movement,” says Air Force flight surgeon Dr. Joshua Appel. He no longer uses ice to treat ankle and knee injuries suffered by his para-rescue jumpers.

However, immediately icing an acute injury like a sprained ankle followed by short, intermittent icing periods can get folks back to play sooner than not icing. When our kids are hurt, sometimes that ice pack is enough to get them to forget that they have a bruise on their knee.

Yet, Dr. Mirkin and others on the anti-ice bandwagon are claiming that icing makes us think we are recovering faster, but science says we are not.

I feel lied to.

I also got stuck on the “think” part of what Dr. Mirkin now teaches. How much of our body’s healing process is psychological? I have successfully used the mind over matter philosophy. In her book Cure, science journalist Jo Marchant explores cases where the mind healed the body. She also wrote about how the mind can keep the body healthy in the first place.

So is ice just a placebo effect? Is it really doing harm? Is it wrong that I find it helpful sometimes?

Boston based licensed athletic trainer Gwen Chiaranda, MS, LAT said it comes down to a few key parameters. Context matters too. “What type of type of injury is it? What is the age of the patient? And what is the application and indication of the modality, i.e., what is the desired outcome or effect?”

She added, “Sometimes as clinicians, we simply want to dull pain reception. Ice can do this nicely. The inflammatory response is undoubtedly helpful, but we don’t want excess bleeding or edema to buildup in a joint or tissue.”

Chiaranda said she has yet to meet an anti-ice doctor but is a firm believer in supporting patients in ways that make them feel their best. “If that’s an ice bath and it won’t hurt them…go for it!”

I recently had a double mastectomy and was prepared to buy ice packs to help with post-surgery pain and swelling. The doctor told me not to. I was told to rest, sleep upright, and keep my compression wrap on. Ice was not part of the healing process. Chiaranda was not surprised by this. “Heat—not ice—is wonderful for relaxing nerve pain and promoting lymphatic drainage.” Based on the drains that were sticking out on each side of my chest, showing me the fluid being removed from my body that is what needed to happen.

The takeaway seems to be this: Icing an acute injury right away for about ten minutes to take away the pain and immediate swelling, followed by gentle movement with rest and elevation, seems to be an accepted formula based on research. Do what works for you under the supervision of a professional medical provider. And if a little ice pack stops the crying when your kid falls down, by all means, do whatever you need to do.