If you google “icing and recovery” or “should I use ice after an injury”, you will see dozens of articles written about how icing has negative effects on tissue repair and recovery. On the other hand, during every NBA, NFL, and Pro Soccer game, you will see players on both teams applying ice to their bodies on the sidelines. So, if you find that confusing, this post is for you.
We will explore the arguments for and against the use of ice, sometimes called cryotherapy, as a modality used in the process of healing an injury. We will look at what the science says about icing and the reasons why so many sports teams, backed by millions of dollars, are still using icing for their players even though google and many scientific papers would tell you otherwise.
Finally, we will explore protocols for icing that respect the new science and 50 years of application by professional clinicians and athletes who are using icing to this day to reduce pain, perform better, and recover faster.
I do want to mention, this post dives into acute topical icing, not cold plunge immersion. In the future, we will be posting about ice baths and cold immersion for mental, emotional, and physical health.
First, let’s look at a simple version of what happens immediately after tissue is damaged due to acute injury. This same process, but on a smaller level, can happen to the soft tissue surrounding a joint during and after extreme bouts of repetitive motion.
Damage > vasodilation caused by histamines and other immune cells> Inflammation and additional immune cells needed for repair > accumulation of waste and cellular debris like nitric oxide and other free radical cells are produced in the repair process > cellular transport of waste away from the injury site.
the immune system can overreach
Our immune systems react with a broad response that is not isolated to the site of the injury alone. For example, if you eat a nut you have an allergy to, your immune response can be global, taking over your entire body, causing everything from hives to the swelling of your airway.
Another example of an overreaching immune response is if you injure one ligament in your ankle the entire ankle can swell up into the size of a softball or melon.
This broad response by the immune system can cause all kinds of secondary injuries, oftentimes causing damage and cellular waste build-up in tissue that was otherwise healthy and uninjured. It can also cause long-term inflammation that reduces mobility in a joint, causing negative movement patterns. For instance, your knee hurts, so your hip stiffens up and your lower back has to articulate in novel ways to compensate, possibly causing back pain.
So the initial damage is due to the trauma, but then we have what is called the secondary damage caused by the accumulation of waste in the form of cellular debris and free radical cells.
Although this is a natural and healthy process, too much accumulation of this waste around the injury site can slow down the rate of repair. You will see shortly, how too much ice or ice applied at the wrong time can do a similar disservice to the recovery process.
Inflammation reduces mobility. This can be good in the short term but if inflammation builds and becomes chronic or the afflicted person reduces movements, like walking that are key to recovery and overall health, then there may be a case to reduce the inflammation using ice and other anti-inflammatory techniques.Initial damage:
- blunt trauma like a fall or cut or repetitive motions, like a pitcher throwing 8 innings or knee pain after an ultra marathon.
- histamines and other immune cells like interleukins that aid in repair but can cause harmful waste build-up over time, in and around the injury site.
Now we know a bit about the stages the tissues go through after being damaged on their way to repair and how the immune response can potentially overreach, causing additional harm. Next, let’s look at why so many people have written about the negative impacts of ice and cryotherapy.
harmful effects of icing
Just like the build-up of waste due to an overreaction by the immune system, icing too can slow down the healing process. Due to reducing circulation and the transportation of healthy, healing cells to the injury site, icing can hinder your recovery from an injury.
At a cellular level, it appears cryotherapy (icing) lasting over 5 minutes of application can slow down many of the key immune cell regulators whose job it is to repair tissue.
what do researchers say about icing?
- In 2012, the British Journal of Sports Medicine published a review of 22 studies on cryotherapy and concluded that “ice is commonly used after acute muscle strains, but there are no clinical studies of its effectiveness.”
- In a 2013, research study published in the Journal of Strength and Conditioning Research reported that “topical cooling, a commonly used clinical intervention, appears to not improve but rather delay recovery from eccentric exercise-induced muscle damage.”
ice and reduction in sports performance
In 2014, the Journal of Strength and Conditioning Research published a study that shows cold water immersion may have negative effects on training gains and adaptation. The research shows that by taking a cold water immersion after training, you may be sacrificing long-term gains in muscle mass and strength. This can result from stunting cell activity crucial for building stronger muscles. Much more on cold immersion and when to use it for health benefits and training gains coming soon.
so here is where we are at
- The immune system heals your body by bringing in immune cells and other healthy nutrients to the injury site and surrounding tissue.
- The immune system response is broad, not subtle, and can overreach and over-respond, impairing the healing process.
- Ice can slow down the immune response.
this study on icing is important!
In 2017, the Frontiers in Physiology, a leading journal in its field that publishes rigorously peer-reviewed research, published a study named “Effects of Topical Icing on Inflammation….” Here was their conclusion, minus the unpronounceable sciencey words.”These findings suggest that, although icing may mildly suppress inflammation… These effects are not sufficient to retard muscle regeneration after contusion injury.”
The scientists and researchers who conducted the study used mice with damaged tissue to look at the effects of icing on tissue repair. Like many before them, they too saw a decrease in some aspects of the immune response but after looking at 90 male mice in this randomized controlled study, the team found no difference in tissue repair between the icing group and the non-icing group after 28 days.
Important to note is that the icing was done one time, for twenty minutes post-injury. This study did not look at the effects of chronic icing. Instead, it looked at a major trauma followed up by the implementation of ice immediately after the injury.
With that said, it appears this study shows evidence that ice in the short term does not harm long-term repair. As most of us know, post-injury icing is one of the best ways to reduce pain so it would be a shame to permanently take it out of the recovery toolbox.
ice can mitigate the overreaching effects of the immune system
Think of a person with an infection who ends up with a high fever and to save their life they are put into an ice bath. The fever was intelligent and a warranted response by the immune system to fight the infection and the ice applied by medical professionals is used to reduce the harm done by the fever.
The same principle applies to an injury. The immune response is fever and icing can reduce some of its potentially harmful effects.
Icing should not be used to replace rest, compression, rehab exercises, or other modalities that are proven to be effective for healing. But icing can be used tactically to reduce pain and aid in the recovery process. So let’s explore some of those tactics.
icing can be used in smart and tactical ways
- contrasted with heat to promote circulation
- to reduce pain post-injury
- reduce excess short-term inflammation and swelling
- reduce long term inflammation and waste build-up
- enhance mobility that leads to better circulation
heat and ice
Ice can be used as a contrast therapy to increase circulation by alternating it with a heat source like an electrical heating pad. By alternating between mild vasoconstriction and vasodilation, new blood and reparative immune cells are transported to the applied site. This alternating cold and warmth can also help transport stagnant waste away from the injury.
long term inflammation and icing
If you are experiencing long-term swelling at an injury site, this inflammation can reduce mobility causing movement problems. Implementing some type of icing protocol is often suggested by most physical therapists to reduce the potential harm caused by excessive swelling. Ice packs, the use of ice as a messaging tool, and cryotherapy compression sleeves for outer extremities should all be tools in your recovery tool kit.
pro athletes and ice
Back to all the sports teams that we see icing Pro Athletes. If icing slows down the immune response, limiting the repair and recovery process of joints and tissue, why do so many sports teams still use ice? Maybe, because it works.
Here is the deal, ice may inhibit certain cellular processes in the short term but if athletes feel better, play more, and think it is helping then it probably is.
In a nutshell, icing can be used in intelligent and tactical ways to enhance one’s post-injury experience by icing in limited quantities for specific outcomes. Those outcomes being; to relieve pain, reduce immune overreach, and address long-term inflammation. Don’t abuse a good thing, icing can slow down the movement of good materials in and bad materials out, so use ice for short periods of time for specific reasons. Don’t believe all the google hype, if icing works to keep you performing at your best, then use it with informed caution.As with any medical issue, seek the guidance of your doctor before using ice or any other modality to treat an injury.
Cryotherapy for acute ankle sprains: a randomized controlled study of two different icing protocols C M Bleakley, S M McDonoug, D C MacAule, Correspondence to: Professor McDonough Health and Rehabilitation Sciences Research Institute, University of Ulster, Jordanstown BT37 0QB, County Antrim, Northern Ireland, UK; firstname.lastname@example.org
Journal of Strength and Conditioning Research: May 2013 – Volume 27 – Issue 5 – p 1354-1361doi: 10.1519/JSC.0b013e318267a22c
Pointon M, Duffield R, Cannon J, Marino FE (2011) Cold application for neuromuscular recovery following intense lower-body exercise. Eur J Appl Physiol 111:2977–2986. doi:10.1007/s00421-011-1924-1