To Ice or Not to Ice?

I get questions about using ice (or heat) almost daily. Lately, it’s been increasing due to the popularity of full-body cryotherapy centers that have popped up everywhere. Joe Rogan has apparently been taking daily ice baths to start his day and talking about it on social media.

All the above, and the fact that everyone’s been icing injuries for as long as I can remember, have led to many questions about our old frosty friend.

Here’s the bottom line: icing injuries delays healing, mainly because ice pushes blood flow away from the injured tissue.

In 1978, Dr. Gabe Mirkin coined the term “RICE,” the acronym for “Rest, Ice, Compress, Elevate.” RICE became the mantra for all of us who treat athletic injuries and is still used across the land on sports teams from high schools to the pros. But Dr. Mirkin recanted on the use of ice way back in 2015. By then, I had been in practice for a while, but I missed the memo. Still, I had found that heat seemed to get way better results with patients, and I never used ice.

So–what should you use in an acute pain situation? Is ice always out? Typically, movement is the answer. Gently loading the injured tissue will lead to much better outcomes than avoiding movement while simultaneously limiting blood flow, which will only prolong the misery.

But what about reducing swelling? I’ve been telling people that reducing painful swelling is the only acceptable time to ice an injury. But in doing my research for this article, I stumbled upon this paper, which states the following:

“When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability. As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics in the wrong direction, increasing the amount of local swelling and pressure and potentially contributing to greater pain.”

In other words, ice can worsen swelling and intensify pain instead of reducing it. Now we both know.

So what should you do in an acute pain situation? The rest of the RICE acronym (rest, compress, and elevate) is still wise in the initial 24 hours after an injury, but it’s good to start lightly loading the tissue as soon as possible. The adage of “walking it off” might be wiser than we thought.

Using heat can help improve blood flow to injured tissue. And since the one thing ice does well is numb pain, which can allow you to function if your pain is intractable, it’s not going to be the end of the world if you use ice to numb it out–just know that you need to get it moving as quickly as possible.

So, instead of diving into sub-zero temperatures to get your week started, maybe get a massage instead.

And, just as I was getting ready to hit the publish button, the following video came up in my Youtube feed: