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Icing (and not the Frosting on the Cake)

danger ice

Anyone who knows me knows I am a big believer in staying up-to-date on the most current literature and eating icing on cake. It’s important to know when the scientific community supports the crazy things we get our clients to do in clinic. I think it is also important to stay on top of controversial topics. So prepare yourself for the controversial topic of… ICING!

RICE (Rest. Ice. Compression. Elevation) has been perpetuated as the gold standard for acute injury management. You would have a difficult time finding someone who hasn’t used RICE in the management of some sort of ache or pain at some point in their life. It has been proposed that RICE will help limit the amount of inflammation in an area, allowing you to return to normal faster. Is this actually the case though?

Here are 3 beliefs you may want to reconsider when it comes to the application of icing. This information is solely meant o make you think critically on why we do what we have always done.

  1. Swelling is really bad and can prevent a speedy recovery. When we first injure a tissue, there is an initial vasodilation (opening of the blood vessels) to allow blood and white blood cells to enter the area. Their job is to help begin the initial cleanup of the area. So, the easiest way for the white blood cells to get to the injured tissue is through the swelling! Swelling also increases our sensitivity to pain, reduces movement and progresses the inflammatory response. This is all in an effort to keep us from further injuring ourselves.  How can the body come up with an appropriate plan of care if we continue to subject the injured tissue to forces it isn’t ready to handle?! We have evolved to swell. Maybe our evolution regarding swelling isn’t necessarily wrong?
  2. Ice will prevent excessive swelling. Well, maybe not. What if I told you that icing may actually increase fluid in the affected area? It has even been hypothesized that icing an injury may restrict lymphatic flow and promote fluid build-up. The natural swelling process isn’t bad, but excessive swelling is! Our lymphatic system is responsible for getting rid of the excess fluid in the area. Long periods of icing may increase permeability in our lymphatic system. This means fluid has an easier time leaking out of the vessels into the injured area! This makes clean-up nice and sluggish. Icing also has been shown to temporarily reduce skeletal muscle activity. We need the squeezing of our muscles to assist the lymphatic system in pumping out excessive fluid.
  3. Icing improves the body’s capability of healing itself. A pilot study by Takagi et al 2011 wanted to see how icing affected injured skeletal muscle in rats (obviously we can’t just start hurting humans for the sake of science!). A specific muscle group of the rats was crushed using forceps. The rats were then divided into 2 groups: one group iced the muscle group and the other group did not. The rats were then sacrificed (muffle tears) and their muscles were investigated. The icing group had significantly less regeneration of healthy muscle tissue. The regenerated tissue also had abnormal collagen formation, making it overall weaker compared to normal collagen. There were also fewer cells in the area, known as macrophages, cleaning up the injured and necrotic tissue.

I know this is controversial. I am only suggesting that one consider some of the newer theories out there surrounding the efficacy of icing. When it doubt, go talk to your health care professional!

Here is the link to the original article by Bahram Jam, PT: http://aptei.com/articles/pdf/Ice-NSAIDs-Paper.pdf

Originally written by Bailey Gresham, RPT.



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