Stop using ice bad for healing injuries

Why is ice bad for healing injuries?

Ice is probably the most widely used therapeutic agent following injury in modern medicine today.

Although its use has developed over time it’s not based on adequate research or proper study.

The cooling effect of ice on injured tissues actually stops the natural inflammatory process needed for proper recovery.

Inflammation is a natural part of the healing process and needs to take place for removal of metabolic waste products and arrival of growth factors to the injured area for regeneration.

Icing most definitely decreases circulation, causes blockages and stops the natural inflammatory process needed for healing.

Ayurveda (East Indian holistic medicine system), Traditional Chinese Medicine, etc. are against the use of ice for healing after injuries.

Research On Detrimental Effects Of Icing On Injuries.

Dr. Nick DiNubile, Editor in Chief of The Physician And Sports Medicine Journal “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”Here’s What The Research And Literature Says?

“When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ‘dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ‘in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.”

The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986

Dr. Nick DiNubile, Editor in Chief of The Physician And Sports Medicine Journal “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”

Or check out this comprehensive literature review from the Journal of Emergency Medicine

“Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?” JEM, 2008; Feb. 25; 65–68
Abstract: Aims: The use of ice or cryotherapy in the management of acute soft tissue injuries is widely accepted and widely practiced. This review was conducted to examine the medical literature to investigate if there is evidence  to support an improvement in clinical outcome following the use of ice or cryotherapy.  Methods: A comprehensive literature search was performed and all human and animal trials or systematic reviews pertaining to soft tissue trauma, ice or cryotherapy were assessed. The clinically relevant outcome measures were: (1) a reduction in pain; (2) a reduction in swelling or edema; (3) improved function; or (4) return to participation in normal activity. Results: Six relevant trials in humans were identified, four of which lacked randomization and blinding. There were two well conducted randomized controlled trials, one showing supportive evidence for the use of a cooling gel and the other not reaching statistical significance. Four animal studies showed that modest cooling reduced edema but excessive or prolonged cooling is damaging. There were two systematic reviews, one of which was inconclusive and the other suggested that ice may hasten return to participation.”

TIP: Instead of ice, we soaked with Epsom Salt+Boiled Ginger Water+Baking Soda as a warm water soak.

This mixture is very helpful not only for pain relief, it improves circulation and reduces swelling.

Hey guys. Stop using ice after injuries. Icing prevents proper healing and slows down recovery after injuries.  It causes more swelling, blocks the fine channels in the body, prevents removal of dead tissues and waste products, and doesn’t allow proper flow of nutrition and growth factors essential for repair and healing.

Transcript…

Hi everyone!  This is Manu Kalia, a physical therapist and Ayurveda herbalist.  Today I want to answer one of the most common question I get asked in my practice regarding recovery after injuries and also probably one of the biggest mistake I think people are making — patients as well as clinicians — in terms of helping the healing process especially after an injury or after surgery, which has to do with the use of ice.  Is it good or not good to use ice to help the recovery process?

I am going to share with you some of the research as well as the western views on this, the western medicine views on this, as well as, the eastern medicine to take on this whole thing.

I have not been using ice for the last seven or eight years now with my patients at all, whether after low back issues, knee problems, or even post surgical patients.  This has to do with my background and training in the ayurvedic medicine tradition. Ice is not used in ayurvedic medicine or traditional Chinese medicine and even some of the Tibetan medicine and some of the other traditions in the healing process, especially after an injury.  Heat is the modality of choice — and I know that this has been so drilled into everybody’s head that immediately after an injury the acronym RICE is used which is Rest, Ice, Compression and Elevation and ice is one of the major components of that.  So I wanted to talk to you guys why ice is not helpful at all.  In fact it slows down the healing process after an injury.

According to the eastern or ayurvedic perspective and traditional Chinese medicine perspective, ice will actually cause more congestion and blockages in the injured tissue.

Remember, you just had an injury in a tissue so you are going to have broken blood vessels, blood cells and all sorts of metabolic waste products from the injured tissue, as well as, healing taking place there.

With the inflammatory process that starts up there you are going to have more fluid in that region also and swelling, as well as, pain.  So adding ice to an area like that is going to actually cause congestion because it prevents the flow of fluids between the tissues.

If I have an injury through here, my elbow and there is swelling, congestion and all these things going on and I ice it down further or I don’t move it, I am going to increase the blockage that is going on in that tissue.  I am not going to facilitate flow of nutrition, fluid and removal of waste products from that tissue and that’s the biggest problem.  If I want to heal that tissue, I want to facilitate flow of nutrition and growth factors into that tissue and I want to remove waste products as well as fluid that have accumulated in that tissue — so opening up of channels is essential.

So that’s why heat is used in the eastern medicine most of the time, I would say.  Remember, cold contracts, heat expands.  You want to open up vessels to facilitate flow of nutrition in those areas and removal of waste products.

The next thing is the adding of ice onto that tissue from the western standpoint.  Remember, it blocks the inflammatory process — and this is a misnomer that everybody thinks inflammation is bad.

We have inflammation there so you need to get it under control by taking oral anti inflammatory medications or I put a bunch of ice on it.  You have to ask the question, why?  Why the inflammation is bad?  Remember, inflammation is a natural response of your body to an injury or something that’s going on in that tissue.

Your body has its own intelligence which has been designed over millions of years.  When you have an injury it causes inflammation.  There is a purpose behind inflammation, which brings in prostaglandins, brings in macrophages which are large cells that basically gobble up the broken down dead tissue and remove the waste products.  Those macrophages with them also bring in Growth Factors which help the healing process and repairing of the tissue.  By blocking that inflammatory process you are actually hindering that repair process, removal of waste products, as well as, the growth factors that come in to help repair the tissue.

If you look around research, this is documented and in fact there are a bunch of studies that support everything that eastern medicine has been saying for so long that ice does not facilitate the recovery process.  It does breakdown that process and that inflammation is important for facilitating or improving that healing process and to make that healing process take place.

So not only ice will breakdown that whole inflammatory process as removal of waste products, as well as, the growth factors that come into repair the tissue, adding of ice actually increases leakage of intersitial fluid back into the tissue.

Now remember, fluid or swelling that’s within the tissue is removed by your lymph system.  You basically have two systems going on.  You have your circulatory system and in that you have your heart, your arteries and your veins, i.e., circulation of blood.

Then you have your lymph system which is a one-way system, it removes excess fluid back into the circulation and removes fluid out of an area and that’s a one-way system.  It works like a pump system which is regulated by the muscles around those lymph vessels which contract to bring fluid back up into circulation.

So the ice will actually increase the swelling in that area.  If you are using ice just to numb the area to make yourself feel better temporarily, fine; then you can continue using ice, but long term it doesn’t help the healing process.  In fact it hinders the healing process and will cause more problems.

Better alternative would be massage — and this is especially true from the eastern perspective — you want to reduce the swelling, whether you are doing massage in that area or some form of compression to that region.

Not necessarily locally, if you can tolerate it locally but even distally, further down.  If I cause compression through here or massage through this region, I facilitate flow of fluid back out of that region; waste products or swelling out of that area and that brings in circulation into that area to help heal the tissue.  So one is massage or some form of compression to facilitate that.

The second thing is movement.  If I can tolerate movement and if the injury isn’t too severe, you want to get that area moving also.  Of course, unless you have some surgical restrictions and stuff you want to follow those also.  Or you can move areas away from that injured tissue to help move fluid in that area.

The other thing looking at the eastern perspective is application of heat would be a great idea.  As I said cold contracts and heat expands which will help not only with pain management but it can also help facilitate opening up the blood vessels and capillaries that facilitate flow of nutrition and fluids as well as opening up energetic channels to help the healing process.

So application of heat, whether a hot pack or for that matter doing a soak for example with Epsom salt in it.  Remember, the Epsom salt is magnesium based, it also helps with pain or actually spasms and will help with the swelling also.  You can even add some baking soda to that, as well as, ginger, which is very good pain reliever also and can be added to a warm water soak and that would be applied to the tissue.

Internally, herbs or herbal formulas can be taken and are given in eastern medicine, first to reduce the swelling, open up the channels, remove blockages, remove waste products and pain control.  So if I have all those things going on your body will do what it needs to do.  Body has a cellular intelligence in it and it knows exactly what needs to be done. You just need to give it a little bit of help to facilitate or help the process.  If I open up those channels or remove blockages and remove waste products, remove the swelling from that area, bring in fresh nutrition and blood flowing things to that injured tissue, control the pain, get some movement going in that tissue, muscular contraction around that region or locally, it will help to heal the tissue.

Then there are specific herbs there that also actually target a specific muscle tissue or bone tissue to help heal that specific tissue.

I hope you find that helpful. As I said earlier, I have been using heat to treat injuries of all my patients for the last seven to eight years. I am not doing something novel; this has been done in eastern medicine for thousands of years, that is, by traditional Chinese medicine, ayurvedic medicine and various other systems. It is just for the last 30, 40, 50 years probably that we are using more and more ice.  But now there is research out there specifically saying that icing does not help the healing process but actually hinder it.

So keep that in mind and think about any questions you might have.  As I said I have had great success in all of my patients recovering faster and having better outcomes, long-term better outcomes.

For the last 50+ years or so people have been conditioned to use the RICE principle and ice immediately after an injury.  Ayurveda, TCM, Tibetan medicine, etc. don’t use ice or cold for pain and recovery after injuries. Now there is lots of research that supports the fact that ice is bad for healing.

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{ 10 Comments… add one }

  • Kamal November 9, 2012, 9:40 pm

    Hi Manu,

    I’m Kamal from India. First of all I would like to thank you for such an informative Videos on your website. These Videos will help a lot of people who are in trouble and searching for the right method of treatment / exercises like me.

    From the last 10 days I’m suffering from what I think is MCL (Medial Collateral Ligament) injury. I searched the web and on maximum websites it was mentioned that ICE Compress will be helpful. I then started Ice treatment and have temporary relief only. I’m also applying Ayurvedic Gel “Rumalaya” on it and putting Knee Cap while I sleep. Putting Knee Cap gives me a lot of relief. But then question remains the same, Ice is not helping me permanently. After viewing your Video I’m sure that ICE treatment is not going to help me out and now I’m going to start HEAT treatment as per your suggestions.

    Can please elaborate, how many times a day should I apply Heat on it?

    Earlier I was Obese and weigh around 98 kg. But after an eye opener event in my life I decided to reduce my weight to 75 kg by 31st December 2012. At present my weight is 81 kg and I’m on the track to achieve my goal well in time. I used to walk a lot (brisk waliking). Due to brisk walking and healthy diet I was able to reduce a lot of weight. But my tummy is still having some fat on it and I decided to RUN instead of Walking. I ran around 50-60 kms and this MCL injury happened to me. I think my shoes could be the culprit here as the shoes which I wear during walk are meant for Walking only and not for Running. They doesn’t have flexible sole. Also the sole of my left side shoe is slightly more rubbed from inside which I think due to this all the strain was put on my MCL and I got this injury.

    I will be very thankful if you clear my doubts and answer my querry with some suggestions.

    Regards

  • Bob Santos November 16, 2012, 6:15 pm

    Right-on Manu! I’ve been telling my clients this for years.

  • Manu Kalia November 18, 2012, 9:25 pm

    Hi Kamal, glad you found the videos helpful. You can continue massaging and applying heat 2-3x/day. Mahanarayan oil is good too. For MCL strains, cross friction massage is helpful if there area adhesions or scar tissue after injury. Wearing a brace to support the knee is helpful too. If you have flat feet this can also put excessive stress on the inside of the joint and can irritate the MCL when when starts running. Proper shoes and orthtics (shoe inserts) to support the arch are very important and helpful. Hope this helps.

    Best

    Manu

  • Manu Kalia November 18, 2012, 9:31 pm

    Thanks Bob…I am glad there are more of us who are spreading this message to our patients.

  • May April 2, 2013, 3:25 pm

    Hi Manu,
    Thank you so much for your helpful videos, I just had arthroscopic knee surgery and wanted to know which herbs or herbal formulas can be taken to reduce the swelling, open up the channels, remove blockages, remove waste products and pain control. Also in my case is movement and excersise helpful?
    Again thank you for your great and informative videos.

  • Manu Kalia April 4, 2013, 3:38 am

    You are welcome. Turmeric (as long as you are not on blood thinners after the surgery) and Kaishore Guggulu formulation can be taken orally. Regular massage of the thigh, calf and the knee (once the incision are closed) with Restore Ayurvedic herbal oil http://www.amazon.com/Anti-inflammatory-Discomfort-Associated-Tendonitis-Fibromyalgia/dp/B007YMTAGC/ref=sr_1_2?ie=UTF8&qid=1365046503&sr=8-2&keywords=tridosha+wellness+products. I don’t have my patients use ice, heat is much more helpful.

    Follow my non-weight bearing exercise video, will help. Avoid excessive walking and use your crutches or walker to take pressure off the knee. Exercises also depend on what problem you have surgery for. Hope this helps.

  • Manoah Gerah Cabiles May 11, 2013, 5:06 am

    Hi Manu,

    Thanks for info on knee injuries. But i have some questions.

    I’ve had a left lateral meniscus tear for more that a year now.i’ve done series of exercises given by my ortho.right now, im doing the weight bearing exercises.i noticed that the pain from my lateral change its location.it is now in the middle or just under the pattela.should i stop my exercises? Is this change normal when in process of healing? My ortho requires 3x a day of ice with fastum gel. Should i stop the ice? My pain is 2-3% out of 10 when i walk.

    Thanks so much!
    Manoah Cabiles

  • Manu Kalia May 17, 2013, 8:41 am

    What exercises are your doing? Squatting? Lunges? Pain under the patella could also be patellofemoral pain, possibly a separate issue than the lateral meniscus issue. I don’t have my patients use ice, I have them use heat.

  • Wendell John September 2, 2013, 4:27 am

    Thank you for this Post!! It’s given me another perspective to approach my injuries from. How would you go about treating a hamstring strain? Everywhere I search, RICE is the most common treatment with a emphasis on ice. I’d say the injury is a grade 1 strain… Thanks in advance!!

  • Manu Kalia September 2, 2013, 9:33 am

    You are welcome…If the goal is to numb the area and not feel pain ice is fine. If the goal is to heal the area, no ice. Deep tissue and/or cross friction massage to the injured area and surrounding tissues with herbal oils or liniments to improve circulation and prevent adhesions or break down adhesions. Light stretching and mobility exercises to maintain tissue extensibility. Once tissue is healed start strengthening.

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