Things I wish I knew before. . .

Updated as of 5/11/23

My child sprained an ankle and immediately, every well-meaning person around us kept at us with ice, and more ice. The day after the injury, our sporty, super-fit friends quizzed me, double-checking that we were continuing to ice the ankle. All this emphasis on ice gave me pause, because in traditional Chinese medicine (whose philosophy I have followed growing up), ice is never used for an injury. These opposing views sent me running to Google.  

It turns out that recent research suggests icing an injury may not be the best way to heal an injury. In fact, a new March 2021 study found that ice may be more than just unhelpful, but may actually slow healing!

My findings

The bullet points below summarize the basic arguments against using ice:

• For years, ice has been widely practiced as the standard treatment for sprains and sore muscles. However, recent research has determined that both ice and too much rest may actually delay healing. In fact, Dr. Gabe Mirkin, the doctor who coined the term RICE,  Rest, Ice, Compression, and Elevate in 1978, wrote an article in 2015 stating that he now believed this method actually delayed, rather than helped healing.
• A review of 22 research papers found little evidence that ice and compression helped healing over the use of compression alone, so there is actually scant scientific proof that ice helps
• Controlled blood flow and inflammation is needed for the body part to heal and ice (as well as anti-inflammatories like ibuprofen, and other pain reducers) work against them, by shutting or slowing down blood flow to the area and turning off your body’s natural immune response of inflammation
• If ice is used at all, it should just be used briefly and is only for the benefit of pain relief. You should use ice in those instances, but be aware that it may slow your recovery.
• Instead of ice and rest, do movements (gently as needed) but as soon as possible. According to renowned physical therapists, Dr. Jim and Phil Wharton, “inactivity shuts the muscle down. Blood flow is restricted and tissue atrophy follows. In contrast, activity improves blood flow, which brings oxygen and removes metabolic waste.”
• Icing may slow healing. It may be disrupting the body’s natural cell process in a way that actually delays muscle recovery according to a March 2021 study done on mice. Apparently, there are enough similarities between animal and human muscle to suggest that the body’s muscles may know how to heal itself better without the ice.

Ice vs. no ice is still widely debated and you will find professional, medical voices on both sides. However, if you do a search, you will find most articles by orthopedists, physical therapists, physicians alike advising you to use ice. It seems the idea of ice not always being helpful or necessary is either not well-known or perhaps not acceptable to most people in this field where the idea of using ice for injuries has been ingrained for some time. I found that our own orthopedist at a well-known sports medicine clinic prescribes ice. 

My takeaway

This turned out to be a much more controversial topic that I expected it to be. It definitely reinforced my propensity to question conventional medical wisdom (5 Reasons Not to Rely on Doctors). Arguably, I found the evidence to back my personal bias towards of not using ice. There are other ways to address injuries that may also be better at preventing recurrence. I saw arguments ranging from ice is harmful, to neutral, to helpful. I think at the very least, I saw that ice is not necessarily helpful nor necessary, (and I won’t have to feel like I wronged my child by not giving ice). 

Resources

The case for ice: 

• https://www.cramersportsmed.com/first-aider/to-ice-or-not-to-ice-that-is-the-question.html
• https://health.usnews.com/health-care/for-better/articles/2017-04-03/the-sports-injury-conundrum-heat-or-ice
• Most articles (by orthopedists and about standard treatment for sprains and strains will tell you to ice)

The case against ice:

• https://www.nytimes.com/2021/04/21/well/move/exercise-icing-sore-muscles.html
• http://stoneathleticmedicine.com/2014/04/rice-the-end-of-an-ice-age/
• https://www.verywellhealth.com/why-you-shouldnt-do-rice-for-sprains-4144771
• http://thischangedmypractice.com/move-an-injury-not-rice/
• https://www.drmirkin.com/fitness/why-ice-delays-recovery.html
• https://www.athleticsweekly.com/performance/ice-delays-recovery-15471/
• https://www.verywellfit.com/when-to-ice-3120707
• https://www.chicagotribune.com/lifestyles/health/sc-hlth-icing-injuries-0320-20190319-story.html

Links about the ongoing debate of ice versus heat:

• https://www.sidelinesportsdoc.com/revisiting-ice-after-injury/
• http://garyreinl.com/articles/The-Cold-Hard-Facts.pdf
• https://mikereinold.com/is-icing-really-bad-for-you/
• https://theconversation.com/when-treating-sports-injuries-does-the-west-do-it-best-90526

Traditional Chinese Medicine (TCM) rationale against ice:

• http://thedragontree.com/2015/05/21/bouncing-back-from-summer-sprains/
• https://www.theworldofchinese.com/2013/03/tcm-for-sprains-and-strains/
• http://www.ahealthybalance.ca/blog/heat-vs-cold-for-injuries-and-pains-a-traditional-chinese-medicine-perspective
• https://www.acupuncturetoday.com/digital/index.php?i=712&a_id=33340&pn=41&r=t&Page=41