A Chinese Medicine Perspective On The Ice Debate.
At some point, the notion that ice facilitates the healing process became conventional wisdom. Ice is somewhat of a gold standard in athletic training rooms across the country, and it is used without question on ankle sprains, torn hamstrings, or most any acute injury. This is not the case in Chinese medicine, where the perspective is that “ice is for dead people.” Ice is almost never used on injuries; in fact it is considered to be detrimental to the healing process and is thought to cause chronic problems later in life.
Why Ice is Not The Answer: The Chinese Perspective
Ice is quite useful for preserving things in a static state, but it does not help damaged tissue repair itself. In Chinese medicine, there is a saying: “where there is pain, there is no free flow; where there is free flow, there is no pain.” Ice essentially stops the free flow of blood and fluids; it causes the contraction of local blood vessels and soft tissue. This may inhibit the restoration of normal circulation (which is critical for healing). Extensive use of ice is believed to cause an arthritic type of pain down the line that is worse with weather changes (especially cold and damp) and is difficult to treat. Ice is considered a major culprit in joint injuries that don’t heal properly.
So why does everyone use ice? And is this practice rooted in evidence?
Ice is used because it is thought to 1) reduce inflammation 2) reduce pain 3) reduce swelling 4) promote healing.
Ice certainly halts the inflammatory process and reduces pain, but the question is, do we really want to stop this? The body is very intelligent; why do we want to interfere with this natural process? The splinting and spasm of soft tissue (often resulting in pain) is the body’s attempt to prevent you from further damaging the already injured tissue. The inflammatory process is how the body heals itself. Tissue healing will not occur without inflammation. Stopping the inflammatory process (either by the use of NSAIDS or ice) is essentially preventing proper healing. Ice has been shown to suppress levels of IGF-1—an anabolic marker that usually increases after injury or exercise and improves healing and recovery.1
A healthy healing response is one in which inflammation occurs and then is quickly flushed out by the body. Problems occur when this inflammation and swelling get “stuck.” The stagnation of blood and interstitial fluid will prevent the timely and complete healing of tissue, so that IS something that needs to be addressed.
The thing is, ice doesn’t help with this. Many people use ice because they think it reduces swelling. Ice does not reduce swelling; the lymphatic system does. In fact, ice has been shown to actually reverse lymphatic drainage, causing backflow of fluid into the injured area and worsening edema.2 So, what does promote lymphatic drainage and reduce swelling? Elevation, compression, massage, and movement of the affected area. Essentially, anything that promotes circulation and movement of fluids will help the lymphatic system do its job.
What To Do Instead of Icing?
So, we don’t want to suppress the inflammatory response, but we do want to flush out that inflammation. We want to promote circulation and reuptake of stagnant fluids so that normal movement and function can be restored.
The following methods have been used for thousands of years in Chinese medicine to speed the healing of injuries by promoting circulation and supporting the lymphatic system, not by suppressing the inflammatory response:
- Acupuncture or acupressure on specific points that stimulate circulation, increase lymphatic drainage and reduce pain at the site of injury.
- Cupping and/or bleeding the local area to draw out and disperse blood and fluid that is blocking normal circulation. This may sound strange, but it often reduces pain immediately.
- Self massage with liniments that promote circulation and increase lymphatic drainage.
- Herbal poultices or plasters that reduce inflammation but also stimulate circulation and tissue healing.
- Range of motion and strengthening exercises to restore normal function to the injured area.
So, Should I Never, Ever Use Ice?
Ice (and NSAIDS for that matter) can be powerful tools to kill pain and reduce inflammation. If your primary goal is to resume intense training or racing immediately, then ice will certainly help you do these things. If your primary goal is to speed healing, restore full function, and maintain the longterm health of that injured tissue, then skip the ice.
Other interesting posts on icing injuries:
- Nemet, Dan et al. “Effect of Local Cold-Pack Application on Systemic Anabolic and Inflammatory Response to Sprint-Interval Training: a Prospective Comparative Trial.” European Journal of Applied Physiology4 (2009): 411–417. PMC. Web. 22 Feb. 2015.
- Meeusen, R. The use of Cryotherapy in Sports Injuries. Sports Medicine (1986).Vol. 3. pp. 398-414.