Where Do We Stand on Icing An Injury?
There are three occasions on which it is definitely appropriate to use ice.
1. You just crashed your bike/you face planted while going up the stairs on a trail run/your kid threw a giant rock at you, and now there is a giant purple swollen mass on your leg/arm/head.
2. You have heat stroke.
3. You are on a beach in Puerta Del Mar and that ice is going in your drink.
Notice what is not on that list? Your chronic Achilles tendinopathy. And your post-long ride ice bath.
To answer that, we have to step back and look at why people think icing is good for injuries and recovery.
Popular Misconception #1: Inflammation is bad. Ice decreases inflammation. Therefore, ice is good.
First, the whole inflammation-is-bad debate: we’ve seen somewhat of a paradigm shift in the last 10 years. On the one hand, inflammation hurts. That’s why people love NSAIDs (non-steroidal anti-inflammatory drugs, e.g. ibuprofen, naproxen). You take them, you block production of some of the enzymes that make inflammatory molecules*, and you hurt less.
* If you are curious about this, take a biochemistry class, or send me a message and I will talk to you endlessly about cyclooxygenases and prostaglandins, because I am a huge nerd.
So why would getting rid of inflammation be bad? Possibly because you need inflammation to heal. Like most things the human body does, it exists for a reason. The inflammatory response is not just some cruel twist of nature/evolution/God, no matter what Donald Trump says.
For those still curious about how inflammation leads to healing, take a look into prolotherapy – a treatment method used by some orthopedists, in which what is essentially an irritant (typically dextrose) is injected into tendons to cause an inflammatory reaction and re-kick-start healing of stubborn tendinopathies.
…Which leads straight into the second – and even more significant – point: MOST INJURIES YOU’RE ICING ARE NOT INFLAMMATORY!!!!
Read that sentence over and over again. I’ll wait.
Ok. This is the most likely reason why ice will not help your injury. In fact, let’s just set aside the when-is-inflammation-good-vs-bad debate – if there is no inflammation to block, ice is not going to do anything.
The overuse and repetitive strain/stress injuries suffered by your average endurance athlete are a different animal. Only in the very early stages is there inflammation present. Most of what we call “tendonitis” would be better labeled “tendinosis” – if you biopsied your chronically angry achilles, you’d see a structurally broken down grey-ish ugly tendon. If you went down to the microscopic level, you’d see disorganized collagen fibrils. In other words, signs of degeneration. Same for shin splints, joints with cartilage breakdown, and bursitis.
Ice doesn’t fix that.
Well-intentioned misguided-ness #2: Ice will decrease my DOMS.
This is not a misconception. In fact, a ton of research supports the idea that jumping into a tub of ice after your workout WILL decrease the amount of delayed-onset muscle soreness you experience.
The point I want to make here is: is that really something you, as an athlete, want to do?
Because these studies also show that the effect of cold therapy on DOMS is one of relieving PAIN, not repairing muscles faster. And, that can come with a performance trade-off.
Popular Misconception #3: I will recover and perform better if I jump in a tub of ice after my hard workout.
- During and after exercise, your body releases anabolic hormones (e.g., growth factors). Ice application immediately after exercise has been shown to decrease circulating levels of growth factors (for a nice review, see this long article). So, an ice bath may block some of the anabolic (building) effects of exercise. Yes, this goes for endurance exercise too, not just heavy lifting.
- With 4-6 weeks of exercise (cycling, in this study), artery width in your muscles increases – which leads to improved blood supply, which leads to better circulation of all the things that allow hypertrophy, regeneration, etc. This effect was shown to be significantly attenuated in a cold-water immersion group – so muscle hyperthermia appears to be pretty important for these adaptations.
- Again, ice is intended to blunt inflammation. Inflammation, in the context of that which is produced by a normal training session, is your body’s signal to adapt. So again, by decreasing training-induced inflammation, you also decrease the stimulus to build back stronger. Here is where I think smart timing comes in – if you’re near your peak and focusing on race day, the analgesia from the ice makes you feel good, and additional training adaptations are irrelevant, then sure, go ahead. However, if you’re in a build phase, you don’t want to block the break-down, because you’re still trying to build up. In other words, don’t lose the forest for the trees.
There may be certain benefits to cold water immersion, too – for instance, reactivating your parasympathetic nervous system more quickly (if you’re into things like heart rate variability, you know what this means). Basically, it may put your nervous system back into a “resting” state, and could thus possibly facilitate central nervous system recovery over the long haul. If this is more of a priority for you than muscular adaptations, then the ice bath may not be a bad trade-off.
Bottom line: decide what you’re trying to attain with your icy immersion. Life is about simple pleasures, and if one of your simple pleasures is freezing your balls off in your bathtub after your 7 hour Saturday Smashfest, then don’t let me stop you.
But for %Y*#’s sake, stop icing your 5 year old knee injury.