Pretty much anywhere you read on the internet would undoubtedly inform you to ice any ache, pain, or injury without question. But is this actually sound evidence-based advice that is in the best interest of each and every athlete? The answer, ladies and gentlemen, is a loud resounding no! This is outdated information, that even the pioneers of such advice have retracted on. If that doesn’t give you the answer I don’t know what does. For example, Dr. Gabe Mirkin, who advocated for the “Rice Principle” back in the late 80s, has openly admitted that he was indeed wrong, and as you will see, several authorities have backed that up for reasons as to why ice isn’t the answer when it comes to treating injuries.

Meet Dr. Josh Stone

In a world full of posers that stand on the back of giants, it becomes increasingly important to give credit where it’s due. In this case, Dr. Stone is someone who immediately jumps to mind, since he was one of the first to advocate against icing for treatment approximately two decades ago. It’s pretty sad how long it takes for irrefutable concepts and ideas to become realized. But better late than never I suppose.

But icing feels so good….

This is one area where icing thrives in relieving the pain sensation that exists post-injury or inflammation. 1 According to world-class physiotherapist Florence Kendall, the icing creates a topical analgesic effect. It’s similar to what you would experience by putting some Bengay or Blue heat on an area. It numbs you up for a bit until that pain returns, maybe even more so than before. Is that what you want is a band-aid fix? Because that is all you are getting with these types of common treatment methods, unfortunately. As you will soon see the only real solution is rest, recovery, and progressive overload exercise. 1

Movement is healing

“We indeed want to limit excessive inflammation and facilitate the removal of inflammatory byproducts from the injury site. However, ice/cold does not do this. Ice prevents movement and removal. To limit excessive inflammation and remove inflammatory byproducts, use compression, elevation, and massage, not ice.” 1

And here is the icing on the cake in the words of Dr. Stone:

“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). Ice does nothing to facilitate collagen formation. Tenocytes are spread out and have octopus-like tentacles that connect cells and fascia. When a load isintegrin applied to a tenocyte, the force is transmitted to neighboring cells. The neighboring cells receive the signal through receptors called integrins. The integrins then carry the signal from the outside of the cell to the inside. This signal is then carried down actin filaments to the cell nucleus, where transformation occurs. See the image to the right for a visual.”

Our body has all types of cells (osteo, white, red, fibro, etc.). Stem cells have no idea what they will be in the future. Then there are progenitor cells. These cells have some idea what they will be, but can still be manipulated and changed to a specific cell type. So a progenitor cell can become an osteocyte, chondrocyte, tenocyte, etc. Load in the tendon tells our body to turn a progenitor cell into a tenocyte. A load in bone tells a progenitor cell to become an osteocyte. Why do bone stimulators work? We load bone using sound waves to apply mechanical force on bone. Similarly, athletes’ tendons are thicker and denser because they load tendons more.

The acronym RICE is bogus, in my opinion. Rest is not the answer. Rest does not stimulate tissue repair. Rest causes tendons to waste. You may say, “Yeah but this is an overuse injury, you must rest.” True, overload does cause tendon thickening and tendon stiffness, but rest is not the answer. Appropriate load IS the answer, as it stimulates metabolic processes of repair.

The other reason RICE is bogus is obvious, as the blog title indicates, ice. Evidence shows that cryotherapy slows metabolic processes and nerve conduction velocity. Metabolic pathways are necessary for human function. Cells are supposed to produce catabolic and anabolic reactions. This is a constant process in all humans. During healing, we break down and rebuild tissue. Cold inhibits this function, so in a sense, we are slowing the necessary catabolic and anabolic pathways.

I heard a great discussion about ice and stim at the NATA conference. Ice is designed to reduce pain by decreasing nociceptor fiber response and slow nerve conduction velocity. Stim (IFC / Premod / Biphasic waves) is designed to pump impulses at a high frequency to stimulate large-diameter nerve fibers and override pain fibers. But if Ice slows nerve velocity, then why do we combine cold with high-frequency stim? Is this not counterproductive? What happened to good ole rehab? Why use modalities and rest when you can rehabilitate? And don’t use the argument for a time crunch, as I already wrote a blog on creating a beneficial rehabilitation program in 15 minutes.

It just makes no sense. The NATA and BOC are emphasizing clinicians’ use of evidence-based practice. If you are a clinician, use the evidence and steer away from traditional thought if it does not work.”

SCIENTIFIC REFERENCES:

#1-https://athleticmedicine.wordpress.com/2013/07/03/ice-worthless-and-overused-exercise-worthy-and-underused/