9/24/12

Icing


I decided to attempt to conquer the monster that is the icing debate. People are choosing sides in the should I, or should I not ice debate. If you haven't heard of this then let me dip your toe in the pool of therapeutic recovery. The video that sparked debate was done by MobilityWOD.com and proclaimed how we've been wrong by icing. The science is more hypothetical than factual but it made some great points.

What Is Inflammation?
Before we go much further everyone needs to know why the debate ever started. The argument is whether we should allow the body to go through its natural inflammation process or should we prevent it. Inflammation is the body's response to a stress. If you roll your ankle it will swell, this swelling is due to inflammation. Many theorize that swelling is also a pre-medicine form of casting someone so that they don't exaggerate an injury. When we exercise we actually cause an inflammatory response and the body adapts to the stress and is more apt for survival. A unique situation I see in many fitness communities is that they abhor inflammation and eat an anti-inflammatory diet but then workout three times a day.

When we have inflammation C-reactive proteins are released due to the stress. We see the same protein in high levels among cancer patients. One research team injected humans with C-reactive proteins and the area became inflamed and began to coagulate[2]. C reactive proteins are also highly associated with Coronary Heart Disease [3].




Why Not To Ice:
MWOD uses literature that suggest high volumes of icing increases the permeability of lymph nodes and therefore the fluid that our body is trying to suck from the area just sits and floats around. In theory this leads to extra edema [1]. Also quoted is something along the lines of why would we consider our bodies natural inflammatory response a mistake. It makes a lot of sense when you look at it from a distance. The conclusion is that we should exclude icing to only pain management and that movement, compression, and elevation are only what we need.

Why To Ice:
When we do see an injury, inflammation occurs and causes a decrease in Oxygenated blood flow to injured areas. With decreased oxygen in the blood the tissues don't get the nutrients they need. This is called secondary hypoxia, or oxygen deprivation. By icing we decrease the surrounding inflammation and allow for higher levels of oxygen to reach damaged tissue sooner.

The Conclusion:
We have been abusing ice for years and finally someone stood up against it. However, people are extremist and have to have absolutes. In reality icing is not a crime, but abusing it is. If the injury is fairly new then icing is appropriate, a rule of thumb is within 24-48 hrs. Icing for more than 10 minutes can create permeability of lymph nodes though. Therefore, we should limit it to no more than 10 minute bouts of icing. Inflammation is said to last up to about 5 days, so if you still feel some inflammation at this point don't worry. Past this point circulation of lymph nodes is priority and this can take weeks. The body will be trying to mobolize dead tissue and restore normal circulation. The body will also be laying down collagen, or scar tissue, and we need to prevent this from being too aggressive. Movement and stretching are crucial towards the end of inflammation. Compression will allow for the body to naturally stimulate the flow of lymph nodes [4]. For this we need to use wraps and even compression clothing.

The treatment regimine would be to ice briefly and for no more than 2 days past the injury. Use compression therapy the entire time, this can be done for up to two weeks. After the initial week of injury breaking excess collagen will be improve muscle recovery. This means moving and stretching the affected area. These should all be done with care.

This is about as brief as I could have made this debate. We don't need to eliminate icing but we don't need to worship it as a fix all either. Later this week I will write about some of my personal case studies on not icing.


  1. The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986
  2. Erik S.G. Stroes (2005) 
  3. Activation of Inflammation and Coagulation After Infusion of C-Reactive Protein in Humans. Retrieved doi: 10.1161/ 01.RES.0000163015.67711.AB
    1. Mark B. Pepys, MD (1999) 
    2. C-Reactive Protein, a Sensitive Marker of Inflammation, Predicts Future Risk of Coronary Heart Disease in Initially Healthy Middle-Aged Men 
      4) Peggy A. Houglum (2005)Theraputic Exercise For Musculoskeletal Injuries Second Edition. pg 43

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About Me

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BS, MS - exercise Physiology
EPC - Board Certified Exercise Physiologist

Published Thesis
The impact of three different forms of warm up on performance


The Effects of Glucose Supplementation on Barbell Velocity and Fatiguability in Weightlifting - A pilot study"

Graduate from Midwestern State University, founder of Endunamoo Barbell Club, and Endunamoo Strength and Conditioning. Working to help athletes physically reach their goals and achieve scholarships while spiritually pouring into as many people as possible on all platforms.