Does Ice Help or Hinder Injury Recovery? Lachlan Giles Explains

Recently, a trend against the use of ice in injury recovery, which – if you believe the Internet – has been steadily gaining momentum in the athletic community. Could it be true? Have we been wrong to ice our injuries all this time? If you’re anything like me: an injury prone cartoon character, you need the answer to this question, and you need it now!

Unfortunately, while Google can produce some answers, you still need to filter through the biased, uniformed, financially motivated or oversimplified misinformation first, and that ain’t easy.

Rather than resort to blogs, social media forums or Bro-Science on whether ice aids or inhibits the recovery process, it’s best we find out from a professional who understands the biological mechanisms of injury and healing.

Lachlan Giles is a Doctor of Physiotherapy, who earned his PhD researching patellofemoral pain, had his research published four times, and has worked in the past with both the Australian Judo Team and the Melbourne City Football Club.

 

 

 

But you’ll probably recognise him as this guy:

(Image supplied by William Luu Photography)

Key takeaways from this article:

 

  • The effect of ligament, tendon, and muscle tissue injuries
  • The stages involved in the healing process
  • The role of ice in injury recovery
  • The argument for icing and the possible argument against it
  • Best practices for injury recovery
  • The use of anti-inflammatories

 

 

“With just about any injury, you’re going to have some rupturing of blood vessels. Whether you roll your ankle, break a bone or do anything to get bruising or swelling, there’s going to be blood vessels that are ruptured.”

 

Following injury, the rupturing of vessels results in excess blood and fluid building in the affected area.

 

“Once that occurs, effectively you’re going to have blood escaping into the tissue from what would normally be a concealed blood vessel. From that, the body is going to use platelets to cover the ruptured area and, eventually, the artery closes over and ideally you should no longer experience swelling. Your body has to get rid of the extra blood leaking out of a ruptured vessel, and if there is too much of it, this may delay the overall recovery from an injury”

 

This is something called haemostasis, which is essentially the body’s system for reducing the loss of blood. As Lachlan mentioned, haemostasis occurs three stages:

  1. Vasoconstriction
  2. Temporary blockage at the rupture site via a platelet plug
  3. Blood coagulation: clotting

 

 

This is where the legitimacy of icing argument rears its ugly head.

 

“I think it’s perhaps an over simplification of the issue. The people who suggest to never ice an injury are using the rationale that your body will send exactly the amount of blood to the area that is required to heal the injury; therefore, by icing you are messing with this system.”

 

We will see later in this article that this is often not the case.

 

(Competition photography in this article graciously supplied by William Luu Photography)

 

“There is some validity to the claim that your body will attempt to reduce or control swelling in response to an injury, and a good example of this is when people go into shock as a response to a severe injury, where the blood is directed away from the periphery and towards the internal organs, hence why one of the symptoms is going pale.”

 

This phenomenon is known as hypovolemic shock. Hypovolemic shock occurs after an injury has resulted in a loss of roughly 20% of total blood volume.

 

“However, when you roll your ankle, you generally don’t go into shock. When you roll your ankle you get plenty of blood flow to the injured area.”

 

This is where the argument behind anti-icing begins to fall apart. Gary Reihl in an interview with well-known Doctor of Physiotherapy, Kelly Starrett, states that the body is far better at initiating and conducting the healing process than our conscious efforts. Therefore, there is no need to ice.

However, his explanation conveniently (I say conveniently as he heavily advocates the use of a product called the Marc Pro) omits factors like the intensity of injury and level of activity at the time of injury, which as Lachlan explains, influences the appropriate steps for injury recovery.

 

“When you’re exercising and you get an injury, your blood pressure is really high, especially in areas like the legs. Imagine we’re talking about a ruptured blood vessel, when you’ve got a lot of pressure in this system, it’s much harder to close off [the rupture] than say if you step out of bed first thing in the morning and roll your ankle.”

 

This is where over simplification comes into play, and is often overlooked by those with an anti-icing ideology.

 

“When you’re exercising, your body’s going to have trouble trying deal with the amount of swelling that’s going to occur. When people say your body is going to send the exact amount of blood to the area that’s required, it’s very false because you want zero blood to escape from the area. If their theory was true you would expect to have no swelling at all”

 

In instances where injury has occurred in a state of activity – for example: you tear a ligament in the middle of a Jiu Jitsu class – high blood pressure inhibits the efficiency of the haemostatic response, by sending too much blood to the affected area, hindering the sealing of the ruptured vessel.

 

“The idea behind icing is that your body will send blood generally to an area that’s warm and take it away from one which is cold: it’s basically a mechanism for survival. If you send blood to a very cold area it could lower your core temperature when it circulates back to the heart, which is generally ill advised. This is why your hands may be cold in winter because you don’t have as much blood flow to the area.”

 

In the interview, Gary Reihl states, quite condescendingly, that icing an injury only inhibits the body’s natural ability to heal itself: limiting the outflow of waste and the influx of beneficial blood. However, what Reihl is speaking about is only one part of the healing process and as Lachlan explains, thinking of the healing process as one simple stage is an oversimplification what’s happening.

 

“You do need a healing response. Once sealed [the blood vessels], you need blood cells to come in and start laying down collagen forming scar tissue so the injured tissues can then become strong again. That’s potentially one angle they [anti-icers] are coming at with this theory. Which is actually correct, as you do need blood flow at this stage, and that’s why I wouldn’t say to ice everything all the time.”

 

At the risk of oversimplifying the argument from another angle: icing your injury is generally beneficial at the time of injury and especially in cases of exercise activity, while icing after this time may reduce the efficiency of the healing response. But, does this mean ice is beneficial in all injury cases?

 

“I think it’s very dependant on the area injured. So with our example of the rolled ankle, the anterior talofibular ligament, which is a superficial ligament that basically sits just under the skin, I do think placing ice over that would help reduce the temperature in that area. For a lot of other injuries, for example your back or your hamstring, there’s quite a lot of fat insulating those tissues – for a lot of people anyway. I think for areas like this, ice won’t actually get through. This is because your skin is really good at dissipating the temperature of the ice throughout the body. Therefore, I think icing would be more beneficial in superficial injuries, rather than ones affecting deeper tissues.”

 

Now we know when icing may be beneficial, assessing the injury yourself may not always be a clear cut issue. If you’re unable to consult a medical professional at the time of injury, it’s important you follow some general practices until you do.

 

“First of all, stop your activity. If you’re running around, your heart rate will be high and you’re going to send too much blood to the affected are, making it swell a lot more. After stopping activity, I would say elevating is a lot more important than icing, but only if you can do it. A pretty good example is if you cut the end of your finger, which is actually a pretty good analogy to straining a ligament in that you get ruptured blood vessels in both cases. You could put an ice pack over it and it would probably help a little to reduce some of the bleeding. But, if you took that same hand, and elevated it above your head, you’d probably notice a big difference in how much blood was being released from the area. It’s almost the exact same principle for other injuries. Basically, your heart will pump enough blood, at a pressure required, to get the blood to your head. With this in mind, you can put your foot, or your hand, or what ever you want above your head, and it [your body] probably won’t be as effective at getting blood to that area as it is your head; giving your body a chance to get those platelets in and cover up the ruptured blood vessels.”

 

(Image supplied by William Luu Photography)

 

Another effective practice in the injury recovery process is something called active recovery, or in layman terms: movement.

 

“This is another area I think a lot of people oversimplify. After an injury, at a certain point, you want to start moving again, which is essential to restore capacity of the tissue to withstand load. However this is not always something you want to do immediately, depending on the injury. When you have a fracture for example, you don’t want to perform too much of an active recovery. Your bones need rest to recover and re-join. If you start putting stress on them, you’re going to potentially cause issues like permanent non-bony union, which would be a disaster. As always speak to a medical professional who knows what they’re talking about, preferably a doctor or a sports physician if you’ve got something which looks like a fracture.”

 

This piece of advice should come as common sense. However, as the abundance of information found on the Internet is generally communicated with a short attention span in mind; advice regarding active recovery is often oversimplified and can lead to the assumption that movement immediately after any injury is a good idea.

 

But, as Lachlan explains not all injuries are equal and active recovery definitely has a time and place in the healing process.

 

“For most muscles and ligaments, once you’ve got scar tissue build up, the idea is you want to start moving. I like to think of scar tissue like kind of a glue: when you tear your muscle, you’ve got two ends that are now separated, which you want to put together again. If you just glue them together and simply rest them for your entire recovery, then you go back to your sport; the glue will be very ineffective. Scar tissue adapts to the load, which is placed on it. At first it’s very weak. So if you’ve just torn your hamstring, you shouldn’t do sprints the next day, as it will just re-rupture all the way through the scar tissue. But there’s a little bit of load you can put it through, and each time you do it will actually adapt and get stronger and the collagen, which is what gives it it’s tensile strength, will align correctly in the direction of the forces which are placed on the scar tissue.”

 

At this point, we can now see the logic behind Gary Reihl’s advocacy of the Marc Pro product, as movement – at an appropriate time – aids the healing process through the promotion of blood flow.

 

The other benefit of an active recovery is that it can often help to reduce swelling.

 

“Through your veins you’ve got these little valves, which when your muscles contract actually bring blood back towards your heart, and away from the injured area.”

 

This suggests appropriate movement may be more beneficial compared to prolonged periods of rest.

 

“The worst thing you could probably do for the healing process, when say you’ve injured your ankle, is sit down all day. If you’re avoiding moving your ankle, the stabilising muscles will become weak, so it’s important you move and do strengthening exercises to help those muscles stabilise the area.”

 

Now we understand a little more about icing, elevation, rest and movement where do anti-inflammatory medications fit into the picture?

 

“Believe it or not, the jury is still out on anti-inflammatories. Early in the healing process you want the platelets to close off the vessels so that the scar tissues form nice and strong. The inflammatory process here is actually part of the healing process, bringing the platelets in and forming scar tissue, and some studies suggest anti-inflammatories may inhibit that. The research isn’t 100% on this yet, but some studies are suggesting you may heal a little bit weaker if you’re taking them. So lets say again you tear your ankle ligament and your body wants to lay down collagen, which will give it structural strength, taking anti-inflammatories may mean less of that. Again, the research isn’t 100% sure yet whether collagen is specifically affected, but that’s the basic premise.”

 

As you may have guessed from the running theme of this article, there’s the possibility of oversimplifying the use of anti-inflammatory medication.

 

“You have to look at the type of injury. Lets say it’s your joint that’s injured, like a tear in your meniscus, which doesn’t heal, then inflammation might be the primary thing we want to get rid of, and in that case anti-inflammatories might be recommended. But again, speak with your sports physician or doctor first before you decide to take them or not.”

 

Lachlan and his partner, fellow BJJ killer Livia Gluchowska, own and operate the PhysioLab located in Melbourne, Australia .

Phone: 0422 442 408

Email: info@physiolabmelbourne.com

Address: Rear Level 2, 30 Inkerman Street,

St Kilda, Vic 3182

Leave a Reply

Your email address will not be published.

three × one =