[Guest Blog] Josh Stone: 10 Reasons – Icing Injuries is Wrong

Icing for injuries

Ice-ice, maybe?

iceWell, according to Josh Stone, ATC and all-around smart guy when it comes to human performance and injury, it’s a no-no.

From his blog, Stone Athletic Medicine and with his permission (thanks Josh!), we’ve re-posted his anti-icing article for good reason… we all should learn more and challenge long-held beliefs, (just in case they were all wrong).

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Article originally published by Josh Stone

If you know me, you are aware of my anti-ice stance. The ice debate continues to heat up. As peer-reviewed data continues to pour in, the evidence for the use of ice to treat musculoskeletal injury still lacks. I’ve written about ice many times, but many of my anti-ice articles are science-y and focused around one topic. I wanted to do something different this time. I wanted to keep it short, sweet and comprehensive. So, I bring you 10 reasons why we shouldn’t ice injuries.

  1. Inflammation is the first physiological process to the repair and remodeling of tissue. You cannot have tissue repair or remodeling without inflammation. Ice constricts blood flow and impedes the inflammatory cells from reaching injured tissue. The blood vessels do not open again for many hours after ice is applied.
  2. Inflammatory cells are designed to release a hormone known as Insulin-like Growth Factor (IGF-1). 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. The application of ice inhibits the release of IGF-1.
  3. We are contradictory. We have adopted many therapies from Europe and Traditional Chinese Medicine like prolotherapy, acupuncture, and PRP injections. These are all pro-inflammatory, meaning they stimulate or increase the inflammatory response. Studies have found these therapies to be beneficial. Ice does the opposite of these forms of treatment.
  4. Swelling—a byproduct of the inflammatory process—must be removed from the injured area. Swelling does not accumulate at an injured part because there is excessive swelling, rather it accumulates because lymphatic drainage is slowed. The lymphatic system does this through muscle contraction and compression. Ice has been shown to reverse lymphatic flow.
  5. Gabe Mirkin, MD—the physician who coined the term RICE—has since said he was wrong. “Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” – Gabe Mirkin, MD, March 2014
  6. In a position statement (the review of many scientific papers) made by the National Athletic Trainers’ Association on the management of ankle sprains (2013) found that ice therapies had a C level of evidence, meaning little or poor evidence exists. In an interview, the author of that article said: “I wish I could say that what we found is what is really being done in a clinical setting…. Maybe our European colleagues know something we don’t…there is very little icing over there.”
  7.  Ice does not facilitate proper collagen alignment. Diagnostic imaging of chronic tendon injuries like Achilles tendinopathy, jumper’s knee, runner’s knee, and plantar fasciitis show poor collagen arrangement of connective tissue. Study after study shows that exercise (especially eccentric loading) helps align collagen.
  8. Ice impedes cellular signaling and inhibits the proper development of new cells. The processes of mechanobiology and cellular signaling take progenitor cells—infant cells who do not know what they are going to be—and makes them into rebuilding cells like myocytes, osteocytes, tenocytes, chondrocytes, etc.
  9. Ice slows nerve firing and interferes with the strength, speed, and coordination of muscle. A search of the medical literature found 35 studies on the effects of cooling and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running.
  10. Ice does control pain, but that pain relief lasts only 20-30 minutes and as evidenced above, has detrimental side effects to healing. There are many other things we can do to control pain that do not impede healing.

I had a discussion with a physician regarding ice and he said something to me that stuck, “There clearly exists a dogmatic polarization on the use of ice in our medical communities! Old habits die hard. Many colleagues still insist on using ice…despite the current scientific evidence available that shows it does not work.”  Health care providers are supposed to be evidence-based. The evidence is clear that ice is not the best method when treating injuries. Follow the evidence.

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Well said Josh! Get to know him more and be ready to learn by visiting his blog.

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