Sometimes in history we become so convinced of a solution, so familiar with common knowledge, that this becomes a norm. It's widely accepted, it's been tested time and again, and everyone knows what it is. We become complacent with the information, and we stop questioning it and learning more. This is what has happened with icing injuries.
We have been told our whole lives to use ice to decreased pain and swelling, while warding off excessive inflammation and all the bad stuff that comes with it. It's completely common to use ice for a newly sprained ankle, an ongoing achy shoulder, or an irritated back pain.
What if we found out that all those years, we've been wrong?
Would we openly accept new information? Would we include it in our decision making? Or would we just go back to what we've always known and what has worked in the past?
The idea of using ice for pain and inflammation management has been widely used since the 1970s. Even prior to that, as far back as the 1940s, ice was being used in operating rooms to quell pain and infection. In the late 1970s, a landmark publication used ice as a primary treatment for acute (new) injury, and this became widely accepted as the preferred way to treat pain, inflammation, and swelling.
In physical therapy school, we learned the therapeutic effects of ice, how long to apply it, for what purposes, and all the research that has been done to support it. As far as reducing pain, inflammation, and swelling, it really is a wonder treatment.
Why is it though that our body experiences pain, inflammation, and swelling? Why would we want to alter our natural reaction to an injury?
For one thing, we don't like pain. Anything that takes away pain is a welcomed tool. But we feel pain, and we feel it for a reason. Pain is a warning sign. It tells us something has happened. Something is threatening our well-being. We are supposed to feel pain, and if we didn't, we end up with more dangerous conditions and with a shorter life expectancy. So pain is not actually a bad thing. It's uncomfortable. It's certainly not pleasurable. But it is completely normal and necessary.
If we consider the purpose of inflammation, it's the first stage of healing. It's when your body sends out a chemical signal to recruit specialized cells to come help clean up the damage. Without inflammation, healing doesn't occur. When we stall the start of inflammation by using ice, we stall the healing process. That doesn't sound like the outcome we want.
When we consider swelling, we need to realize that swelling is an end result of inflammation. When inflammation occurs, more cells come to the area to clean up the damage. When the inflammatory cells and the cleaned up debris can't leave the area, then swelling occurs. Swelling is a byproduct of inflammation. It's normal, but it should also evacuate the area. This is not altered by using ice.
When we look at ice through this new lens, we see that the negative effects on healing outweigh the positive effects on pain relief. While pain is not preferred, long term damage is worse. Letting your body have an appropriate response to injury allows your body to better heal and repair any damage incurred. Ice does not help with this.
So, how do we help pain, inflammation, and swelling after an injury?
Like we see in so many others areas, let nature do it's thing. Find ways to complement the natural reaction, rather than alter it. Getting light exercise, moving the injured area, and appropriately loading it helps create circulation for both bringing in new cells for repair, and for taking out the damaged goods. Also, we know from pain research that the gold standard for pain management is cardiovascular exercise, at a moderate intensity, for 15-20 minutes a day, and 5-6 times a week. This stimulates our natural pain relieving mechanism and our healing process.
Even though we've used ice for decades, with seemingly good results, we now better understand how healing occurs and how we can support that process. It's hard to break habits of what we've done for long periods of time, but in order to stay evolving, we need to include new knowledge and research, even if that goes against what we previously knew and practiced.
The original author that brought ice as a primary treatment following acute injury in the 1970s has even gone on to redact his prior statement. In 2013, he reported that we now know that ice can delay recovery, and suppress the immune response to recovery. He stated that mild movements help tissues to heal faster, and that ice is no longer the preferred treatment for acute injuries.
We've gained new insight into what we thought would be a standard of care that would always be true. We have to take that information and utilize it for better outcomes and recovery. Ice has a place, but it isn't always the best choice for injuries when our goal is recovery, and not just pain relief, delayed inflammation, and reduced swelling. #snowbeastperformance