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RICE Is Dead. Stop Icing Injuries

Samuel G Oltman, ND, RMSK

Icing injuries or painful joints leads to a short term reduction in pain. It also leads to a long term reduction in healing.

The question when you think about icing injuries is simply: do you want short term pain reduction or long term healing?

Almost everyone is interested in long term healing if they’re presented with the two options. Unfortunately, it’s rarely presented in this way even though the evidence is very clear. This connects to the larger idea of understanding treatments through the lens of short term and long term tradeoffs

Because allopathic medicine has no concept of health outside of the absence of symptoms, this choice is totally overlooked. 

It’s all about blood flow. Tissues that suffer from chronic degenerative issues are ones with poor blood flow: cartilage, tendon, ligament, meniscus, labrum, etc. When there is an injury, promoting blood flow to optimize the original healing response is the top priority. This is also similar to why PRP, a distillation of your own blood, works so well.

icing injuries
icing injuries

There is ample evidence that icing injuries leads to incomplete healing of ligaments and soft tissue, increasing the risk of developing chronic pain/instability/dysfunction. A similar dynamic has been demonstrated with taking NSAIDs: the reduction in short term pain increases risk of chronic pain mediated by the disruption of the healing response. 

There is no question that icing reduces pain and swelling. But is that what we want? Pain and swelling is your body’s attempt at healing: pain prevents you from continuing to use the injured tissue and the swelling is a sign that local blood flow and “chemotaxis” has occurred, the direct way that tissues heal. Is it wise to suppress these symptoms?

Ice/Cold plunges are popular now, aren’t they supposed to be good for you? Yes, they are fundamentally different because you’re getting a systemic effect that increases HR and stimulates the nervous system that you don’t get with local ice on a joint. And the duration is different: a minute or two for plunges, 15-20 minutes for injuries. These two factors, whole body and short duration, make all the difference.  

In the context of an acute injury (for example: you sprained your ankle earlier today), what you want to do to promote the best possible healing response and the best long term results is: 

  • Movement: Start with gentle range of motion exercises (ankle circles for an ankle sprain) and work into increasingly loaded movements as tolerated.  

  • HEAT for short term pain relief and to increase circulation.

  • Brace/compress the area while in use to prevent re-injury. 

  • Topicals (Sombra, Tiger Balm, etc) for short term pain relief and to increase circulation.

  • Do not take NSAIDs (Advil, Aleve, ibuprofen, naproxen, etc).

  • Do not drink excessive alcohol (which you should do all the time anyways). 

  • Optimize your inflammatory response with diet choices rich in protein and antioxidants (which you should do all the time anyways).

When you’re hurt, think: BLOOD FLOW. Blood is how you heal. If the pain persists, see us at Cascade Regenerative Medicine.



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