To Ice or Not to Ice?
In this week’s reading assignments for my courses in Youth Fitness and Strength and Conditioning, the ol’ go to of “R.I.C.E.” came up again. It stands for rest, ice, compression, and elevation (sometimes immobilization as well), and quite often is the standard protocol following an injury.
I’m not a doctor or physiotherapist, but there is some pretty interesting information coming out regarding the ineffectiveness of icing for recovery. Here are a couple of short posts on the topic:
5 Myths About Workout Recovery Debunked by Science
RICE: The End of an Ice Age
As well as an article written by the doctor himself who actually coined the term R.I.C.E.
Why Ice Delays Recovery
This issue hits close to home for me. Obviously each individual case and circumstance is different, but in my case, icing became a crutch to mask pain and hide red flags.
From about grade six on, all I can remember is having the goal of making it to the the next level with basketball. Playing on an American tour team for three weeks in Europe, and at the University of Victoria, was truly a dream come true for my family and I.
I had struggled with shin splints on and off in high school, and they flared up again at UVic. During my first year they started to spiral out of control, and are something I still deal with to this day. I was seeing our athletic therapist multiple times a week, and listening to their advice of icing. It began as after practice, then became before and after practice, then during the day around classes, at night before bed… you get the picture. At one point I remember icing my shins up to seven times a day just so I could play, and although I wasn’t doing this, I had a teammate who was taking up to eight ibuprofen’s daily.
Living a plane ride or very long drive away from home, it was easy to hide how bad it was from my parents and lie to myself. I remember waking up crying in my sleep, and avoiding going to classes with stairs, it was getting so bad. This ended up ending my university basketball career, and years later I found out I had chronic compartment syndrome in both shins on top of shin splints. Chronic compartment syndrome was brought up once early on, but when I was initially tested, I was tested at rest, not after exercising. Eventually, I had a bilateral fasciotomy where they cut the fascia/lining of my shin muscle in six out of the eight lower leg compartments in 2008, five years after I had to walk… or limp away from the sport I loved so dearly.
I’m sure there are cases where using ice is still appropriate, so by no means is my own personal experience to trump that of a knowledgeable health care practitioner. But now I know to ask questions. To not blindly listen when there is clearly something more seriously wrong. Obviously a big part of the issue with me was my unwillingness to stop playing, and to take time off. By the time I had to, so much irreparable damage was done that the surgery was a last resort long shot. Although my shins are not normal, I was told I would never run again, which I was able to after much rehab. I was even able to play basketball again for a short time while I was in the military.
Moral of the story: Just make sure that if you’re using “recovery” or pain-masking medications that you know WHY, and that it’s not hiding a bigger issue. My use of ice became a long-term method of masking pain, and I thought it was helping me recover. In reality, I was numbing my chronic injury, and slowing down, or even inhibiting the healing process. As Dr. Mirkin said in his post that I linked above:
Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:
• cortisone-type drugs,
• almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
• immune suppressants that are often used to treat arthritis, cancer or psoriasis,
• applying cold packs or ice, and
• anything else that blocks the immune response to injury.
I’m definitely not saying there is not a place for any of these tools, especially with acute injuries, but from a recovery, long-term strategy does it make sense? Rehabilitation takes time, patience, and work. Respect that process, so you’re not forced to walk away from the things you love like I had to.