In this episode of The Omega Sports Move More Podcast, hosted by Dr. Scott Jablonka with Carolina Movement Doc, we discover if you should really ice injuries or if doing so delays healing.

Listen to Dr. Scott Jablonka full episode on The Omega Sports Move More Podcast.

After you get injured, do you ice injuries?

Historically, the answer is yes. Recently there has been a lot of controversy and discussion about icing. In this episode, we’re going to look at this intelligently, rather than just saying “yes” or “no.” Hopefully, by the end of the episode, you will find out what is the best route for you, what’s your goal behind icing.

Does Dr. Jablonka ice injuries?

Yes, he does. He has been using it for years, and he’ll continue using it, no matter what kind of research comes out, because it just works for him, and it works for his athletes.

Woman with sprained ankle

What happens when you ice injuries?

Ice is a modality that you put on your body to help “healing.” We don’t know if it truly heals, we just follow the advice of our doctor or therapist. Most of us “put some ice on it” to “help you heal,” without any objective measurements or information as to why it heals. We are doing it because we have been told to.

Recently, there has been a kind of anti-icing movement, that claims that you could be actually doing more harm than good when you ice. This has caused some fear. For the general population, it’s not that easy to decide what is good and what is bad. Let’s break it down.

When an injury occurs, we need to look at the steps and the stages of healing. First, what happens is inflammation which has received a bad name. However, inflammation is the key part of healing and it needs to happen first. This occurs in about 3-4 days. Next, inflammation is followed closely by the proliferation phase, usually 3 or 4 days after inflammation, and proceeds for a couple more weeks. Then begins the remodeling phase which can last for 6 months to a year.

The two phases that we’re really going to hone in on are the first two, the inflammation phase and the proliferation phase because this is where cryotherapy comes into play. This is where claims of icing injuries may do more harm have begun popping up.

Originally, our thought process was: get injured, and you ice it (R.I.C.E – Rest, Ice, Compression, Elevation).

Rest, Ice, Compress, Elevate

What occurs after you injure yourself?

First, the injury occurs and inflammation happens. This is a critical phase of the healing process. Inflammatory cells recognize damage to the human tissue. Once they recognized the injury, the recruitment of other immune cells starts. Neutrophils are the first ones on the scene. They clean up the wound. Then they call macrophages, which are next on the scene. They continue to clean up the wound and secrete a whole range of factors. These factors are pro-inflammatory factors. This helps to get the blood pumping around the area.

People now believe that if you mess with this process, you might be messing with healing, and Dr. Jablonka thinks that’s a valid point. The theory is ice may hinder the arrival of these cells, thus slowing the healing process. It’s important to remember this has not been proven.

Where did this ice concept come from?

In 1978, an American sports doctor Gabe Mirkin coined the term R.I.C.E. He claimed that when you get injured, you Rest, Ice, Compress and Elevate, the latter meaning you have to raise your injury above your heart. This has, since then, been the widely accepted way of dealing with injuries. In 2015, Gabe Mirkin backtracked, saying icing actually delays the healing process and it was only a theory back then.

That’s the beauty of science. It develops, it evolves. We learn stuff, and as we learn, we change our views and approaches.

Let’s look at the effects of ice as it pertains to injury

Ice vasoconstricts. What does that mean? It means that the blood vessels in and around the area become a little bit more narrow. The theory is vasoconstriction equals less blood flow which equals fewer immune cells to the area and equals a slower healing process. How slow, though? We don’t know how slow, since it’s just a theory. However, Dr. Jablonka believes ice is great for pain mediation, it’s great.

What does the research say?

In 2006, there’s a study in the British Journal of Sports medicine that aimed to study the effects of cryotherapy in acute ankle sprains. The results show that cryotherapy was quite successful at reducing pain in an acute ankle sprain.

The question remains: what do you do when you get injured?

If you ask Dr. Jablonka, he’s going to say: “go ahead and ice it!” But he isn’t going to make you sit down for a week or two; he’s going to instruct you to get up and move a little bit.

Let’s take the ankle sprain as an example. You twist your ankle, usually, an inversion. Go ahead and get some ice on that because it’s going to hurt. Don’t put the ice directly on your skin, we don’t want frostbite on your ankle, we want to get to the numbness and start early mobilization. Even if it’s just with your hands, we have to get the ankle to move. Then we want to get into weight-bearing. You have to make sure you haven’t fractured your ankle, which is a possibility. So go ahead and get x-rays done if you’re suspicious.

Dr. Jablonka is not a really big fan of braces. He believes braces restrict; garments support.

What should you buy when it comes to icing?

If you’re in the north, snow does just fine. Pack it in a freezer bag, put it on your body. Really simple and works just fine.

With an elite athlete, maybe a low-level movement approach is okay. Some blood flow restriction is okay. And taping. After an injury, ice it, tape it, move it.

In conclusion, yes, you should ice.

Want more movement tips from Dr. Scott Jablonka? Listen to older episodes of our Move More Podcast.