Ice: The Overused Modality?

Ice: The Overused Modality? | Stone Athletic Medicine

These 2 articles pose some good questions about icing.  I myself only get brief pain relief as long as the area is too cold to feel much, but after it warms back up the pain is unchanged.

“Why are we icing this injury?” I never had an answer that was supported by evidence. So I began my own case study.

There is lack of evidence to support utility of cold for healing.Inflammation is the initiation of healing, so why do we stop the healing process? Inflammation occurs within seconds after injury. Why allow inflammation to start then stop the process? Imagine cars on a busy freeway as cells moving to a location. Then, suddenly a roadblock is applied and only some of the cells make it to the site. How are you supposed to heal and repair if the body is not allowed to do its job?

It is true we want to limit excessive inflammation and we want to facilitate removal of inflammatory byproducts from the injury site. However, ice / cold does not do this. Ice prevents movement and removal. In the case to limit excessive inflammation and remove inflammatory byproducts, use compression, elevation, and massage, not ice.

Evidence has shown that tissue loading through exercise or other mechanical means stimulates gene transcription, proteogenesis, and formation of type I collagen fibers

Tenocytes are spread out and have octopus like tentacles that connect cells and fascia. When a load is applied to a tenocycte the force is transmitted to neighboring cells. The neighboring cells receive the signal through receptors called integrins. The integrins then carry the signal from the outside of the cell to the inside. This signal is then carried down actin filaments  to the cell nucleus, where transformation occurs. See the image to right for a visual.


The acronym RICE is bogus in my opinion. Rest is not the answer. Rest does not stimulate tissue repair. In fact rest causes tendon to waste.

Evidence shows that cryotherapy slows metabolic processes and nerve conduction velocity. Metabolic pathways are necessary for human function. Cells are supposed to produce catabolic and anabolic reactions. This is a constant process in all humans. During healing we breakdown and rebuild tissue. Cold inhibits this function, so in a sense we are slowing the necessary catabolic and anabolic pathways.

Why Ice and Anti-inflammatory Medication is NOT the Answer | Stone Athletic Medicine

“Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”

Much like a fever increases body temperature to kill off foreign invaders; inflammation is the first physiological process to the repair and remodeling of tissue. Inflammation, repair, and remodel. You cannot have tissue repair or remodeling without inflammation.  In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase

Researchers headed by Lan Zhou, MD, PhD, at the Cleveland Clinic, found that in response to acute muscle injury, inflammatory cells within the damaged muscle conduct phagocytosis, contribute to accumulation of intramuscular macrophages, and produce a high-level of Insulin-like growth factor 1, (IGF-1) which is required for muscle regeneration (3). IGF-1 is a primary mediator of the effects of growth hormone and a stimulator of cell growth and proliferation, and a potent inhibitor of programmed cell death. Similarly, in 2010, Cottrell and O’Conner stated “overwhelmingly, NSAIDs inhibit or delay fracture healing”

The Textbook of Medical Physiology says it best:

“The lymphatic system is a ‘scavenger’ system that removes excess fluid, protein molecules, debris, and other matter from the tissue spaces. When fluid enters the terminal lymphatic capillaries, any motion in the tissues that intermittently compresses the lymphatic capillaries propels the lymph forward through the lymphatic system, eventually emptying the lymph back into the circulation.”  Lymphatic drainage is facilitated by contraction of surrounding muscle and changes in compressive forces that push the fluid back to the cardiovascular system.

Inflammation is a necessary component in the first phase of phase of the healing process. Swelling is controlled by the body’s internal systems to attain homeostasis. If swelling is accumulated it is not because there is excessive swelling, rather it is because lymphatic drainage is slowed. The thought that ice application increases lymphatic flow to remove debris makes no sense.

Closing thoughts:

Bottom line, ice and NSAIDs are over utilized. I am not saying never, but I am saying ice is not a magical cure all that fixes everything and is required for healing. It is not the gold standard that it has come to be. My goal with this blog is to get individuals to stop and think before immediately turning to ice and NSAIDs. Is it really the best option?

1 thought on “Ice: The Overused Modality?

  1. Pingback: HHS Report on Pain Mgmt Best Practices – part 2 | EDS and Chronic Pain News & Info

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