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Stop Icing!

Updated: May 8


If you're an athlete, trainer, health professional, concerned mom or dad then you are probably quite familiar with the term "R.I.C.E.".


For those unfamiliar, "R.I.C.E." stands for "Rest, Ice, Compress, Elevate". For generations "R.I.C.E." has been the go-to acronym and treatment of choice for amateurs and pros alike when an ankle rolls, a knee slams into the ground, a wrist gets sprained, or the like.


Here's my main concern for you when you use the "R.I.C.E." protocol in situations like the ones mentioned above: you're not helping your body heal any faster.


I'll show you in a minute that you're slowing down and interrupting the body's natural healing process.


One of the primary reasons folks recommend and use ice: inflammation.


Otherwise known as swelling or edema, inflammation is regarded with as much disdain as fans of the Las Vegas Raiders (we’re a Kansas City business so if you don’t like this analogy, not sorry).


This concern over swelling has created a monster industry for oral anti-inflammatories (think Aleve, as a group referred to as NSAIDs, a.k.a. Non-Steroidal Anti-Inflammatory Drugs).


In 2014, 123 million prescriptions were filled for NSAIDs, and an estimated 1 in 3 people used an over-the-counter NSAID.


The question that entered my mind and eventually flipped my approach to dealing with inflammation in the body went something like this: "Do you really think you're better at healing yourself than your body is naturally on its own?"


Here's a question for you the reader: After an acute injury-we'll use the classic sprained ankle in this example-what is the first phase of healing after the injury?


Anyone?


Anyone?


THE INFLAMMATORY PHASE!!!


Wait, what?


Inflammation is the body's natural response to injury?


So what happens when we delay that by icing a sprained ankle?



A few things:


  • We delay the arrival of the growth hormone IGF-1 (Insulin-like Growth Factor-1). This is the signal your body relies on to kick-start the healing process. Ice delays that.


  • Your body's drainage system, the lymphatic system, actually reverses its function when ice is applied. Instead of carrying fluid away from the injured area, ice increases the permeability of the lymphatic tissue, allowing fluid to back-flow into the injured area.


In summary, ice slows down the arrival of healing elements to deal with the injury and increases the amount of inflammation in the injured area.


If you've ever experienced swelling in a joint, you know it's painful, stiff, and sometimes even hot.


Though these symptoms would lead you to logically believe cooling the area would help, the science just doesn't back that up.


The alternative to the R.I.C.E model has dramatically changed how I practice as a PT and made a huge difference in outcomes for my clients.


As a certified practitioner of The Ready State community, we use an alternative acronym in our community. We call it:


M.C.E

.

MOVE what you can, when you can, safely. Your lymphatic system is a passive system that relies on muscle contractions to pump fluid through the body. If your ankle is sprained, try flexing your calf, bending and extending your knee, or even just squeezing your quad.


COMPRESS the injured area/tissues with muscle contractions and bands (we'll show you how to use our favorite Ready State tool, the Voodoo Floss Band. Here's a good example of how to deal with knee pain and swelling with the floss band:




ELEVATE the injured area when you can. Gravity is a huge asset to help the lymphatic do its job.


Wrapping it up

I know what you're thinking: I can't believe it. I've iced all my life. It always helps.


I was right there with you.


And I was getting paid to do it.


It's hard to reconcile vastly different approaches like this in your head, let alone find the courage to put it into practice.


Our practice and this blog always pursue professional excellence and examine the best practices in physical therapy and strength and conditioning.


If you've been getting nowhere fast icing an injury, let's chat.


You can click the "Schedule a Consult" button at the top of this page and get connected with a real sports medicine professional to give you personal direction on how to feel, move, and perform your best.


References


"Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?" Journal of Emergency Medicine, 2008; Feb. 25; 65–68


“The use of Cryotherapy in Sports Injuries." Sports Medicine, 1986, Vol. 3. pp. 398-414


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2 Comments


Thank you for the great info. I have been questioning icing injuries for several years now. It IS hard to change the thinking. I am wondering how the voodoo wrapping can be applied for shoulder pain.

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Thanks for your comment, Laura! We do not recommend voodoo floss for the shoulder as it can compress the brachial plexus under your arm and create lasting negative neurological and muscular changes.

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