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iceAs athletes, it is drilled into us… ICE YOUR INJURY!

And most of us did. We never questioned it. We iced.

Sprained ankle- ice.

Broken finger- ice.

Twisted knee- ice.

Ice healed all. Ice was the go to. Ice allowed us to go back on the field, finish our race, or continue our game.

That is what I did and what I believed… until I was in school to become a physiotherapist. I remember well our lecture on “ice”, and being somewhat unmotivated for this lecture… why did we have to learn this? It is basic stuff, we already knew all about it- ice should be put on all injuries!

The lecture was designed to give us the facts and taught us the effects ice has on our body, our tissues, our blood flow etc. I remember very vividly our lecturer giving the facts of what cold does to metabolic pathways, injured tissues, inflammatory agents, and blood vessels. And I remember leaving the lecture feeling confused. I was questioning what I thought I had known from my life of playing various sports. I was questioning the use of ice for some situations.

And I still do…

After that lecture my peers and I debated the topic, researched it more thoroughly, and it was up to us to decide our views on ice! Now that I am working and helping patients rehab from injury- I do not have ice packs in my clinic, I don’t use ice for acute injury, nor do I suggest to patients they use ice. And here is why.

  1. Blood Vessels Constrict: Ice is cold. When you put cold on your skin it causes blood vessels to constrict. These blood vessels do no dilate again for several hours after the ice is removed. Constricting the blood vessels at the site of an injury may seem beneficial because it is limiting the amount of inflammation that can enter the injured tissues.  Yes, we want to decrease excess inflammation to an area, but icing prevents the removal of these substances as well. To limit excessive inflammation and remove inflammatory byproducts, use compression, elevation, and massage, not ice. Ice also slows the blood flow to the area that brings in healing cells. Decreasing blood flow (which happens with the blood vessels constrict) could also cause tissue death or nerve damage.
  2. Inflammation is required for healing: Inflammation is required for injured tissues to heal. The cells of inflammation release a hormone (called Insulin-like growth Factor) that aids in tissue healing. Ice prevents this hormone from being release by decreasing inflammation from entering the injured area.
  3. Ice decreases strength and endurance: It has been proven that icing an area decreases the strength, coordination and endurance of the muscles in that area. Athletes in a game need to be aware of this. If you do use ice for an injury and go right back into play post icing, you are at risk of injuring yourself more, as those muscles in the iced area are not at their peak strength or endurance. It is recommended that if you do use ice during a game, you don’t ice for more then 5 minutes and that you warm up the area prior to going back into play.
  4. Metabolic processes slow down: If you do use ice for pain relief do not ice for more then 10 minutes at a time, and there is no point of icing 6 hours post injury. The evidence shows that icing and cold slows metabolic processes and nerve conduction velocity. During healing we breakdown and rebuild tissue- it is a necessary metabolic process of the body. Cold inhibits this function, so in a sense we are slowing the necessary break down and rebuilding pathways. Without this process, healing will be difficult.

Now, I must say that part of the reason there is such debate in the rehabilitation field on ice is because there is little research out there on it.  The research is slowly starting to materialize to give practioners and patients more knowledge on the age-old ice debate.  But, using ice is something most of us grew up knowing. The same way we were told to take a Tylenol if we had a headache, or to eat more protein to build stronger muscles, we learned to ice if we suffered an injury. So it takes a lot of research to sway many of us and to change our opinion. The research is coming, it is just slow to surface!

So there you have it. Take it or leave it, but I encourage you to take the research, the science and the knowledge of your body and your physiology to question what we do and why we do it. Think twice before you ice.