Should I ice?
Dr. Tapplin receives this question a lot simply because it is a fantastic question that does not have one simple answer. While digging deeper into Dr. Tapplin's opinion, and the scientific research discovered, here is what I found.
Dr. Tapplin's Recommendation:
In his office setting, he will utilize laser therapy and it is contraindicated to ice when using laser therapy. The reason for this is because studies have shown it slows metabolism and inhibits the effects of laser therapy. Dr. Tapplin recommends that within the first 24 hours of an injury it is okay to use ice to numb the injured area. He believes that ice does not speed help speed healing, but is a great pain reliever and is a safe option. If patients love icing he wI’ll recommend they can certainly continue but will just have to wait a certain amount of time after having treatment to resume with icing. Of note, Dr. Tapplin is a huge fan of whole body cryotherapy and actually has an ice chest freezer in his basement filled with cold water. He notes there is a difference between whole body cryotherapy and utilizing ice on an injured area.
Digging into the scientific reasoning, I found that there are several arguments on both sides. Gabe Mirkin, in his Sportsmedicine Book in 1978, invented the R.I.C.E acronym. This acronym stands for Rest, Ice, Compression, and Elevation in terms of treatment of an injury. However, Gabe recently discovered that this tactic could potentially delay the healing process.
In an interview that took place on July 22, 2020 by Dr. Kelly Starrett and Gary Reinl, Gary states that individuals should NOT be icing after an injury. The reason behind this is that icing will cause more damage to tissues and nerves, prevent the flow of oxygen, and trap waste in the injury site. Instead, he recommends the best approach is active recovery. Active recovery means using the injured muscle directly through small muscle contractions. This will allow the body to preserve the tissues and help heal the destroyed ones around the site of injury. A saying that is used a lot preceding an injury is “Walk it off.” Although that may sound like the opposite thing to do, it is considered active recovery and can be very beneficial to the healing process.
However, not all research points in the direction that icing could be detrimental to recovery. On the flip side, icing an injury can have several benefits if done right. According to Mike Reinold, cryotherapy “...can reduce secondary injury and reduce edema formation if applied within the first 36 to 48 hours.”. Another benefit of icing is that It also acts as a pain reliever which can have an increase in mobility allowing for active recovery to take place.
Overall, In a podcast on the British Journal of Sports Medicine, Christie Aschwanden speaks heavily on the idea that there is simply not enough research and scientific evidence that suggests icing is beneficial for healing of the injury. Instead, icing could be more detrimental because it impairs the adaptations that muscles make following an injury or post-exercise.
Dr. Tapplin's approach is consistent with the latest evidence and research. He notes that “we have so many more treatment options now than they had in 1978”. Instead of icing, active recovery and rehabilitation should be the mainstay of treatment for many injuries that were previously treated with the RICE method.