The Fallacy of Ice

The Fallacy of IceAs part of my day job as a forensic scientist, I expect to someday testify on a case and have a snarky defense attorney ask me how an undergraduate philosophy degree has any value in my analysis of firearms and fired evidence. My answer is that I use the critical thinking skills honed through the study of philosophy all the time, including in my daily work (plus I hold a Master’s degree in Forensic Science).

While I don’t mean to suggest that anyone who has never studied philosophy is an insightless, gullible moron, there is a great deal of value in spending considerable time studying and picking apart philosophical arguments. We can all use this skill in our everyday lives. And in the coming months on KineSophy, I plan to deconstruct some of the arguments proffered by the health and fitness communities that often go unquestioned. I begin here with the fallacy of ice.

If you’ve suffered a minor acute injury in the past forty years, you’ve likely received the RICE prescription: Rest, Ice, Compression, Elevation. Someone has probably told you to put ice on your sprained ankle, pulled hamstring or bruised shoulder. According to WebMD, ice reduces pain and swelling, [1] and the fitness website Active claims icing prevents inflammation in the injured area. [2] Assuming ice does produce these results, we should first question whether or not addressing these symptoms coincides with healing and recovery. In particular, let us ask “What is inflammation and why should we control it?

Trauma to the body produces an inflammatory response. The damaged cells release chemicals that cause fluid to leak out of the blood vessels and into the affected tissue and summon white blood cells called phagocytes to the site of injury. The released fluid also causes swelling, which helps isolate the foreign substance or cellular damage from the rest of the body, while the phagocytes ingest the germs or damaged cells. When the phagocytes die, pus forms from the collection of dead tissue, dead bacteria and living and dead phagocytes. [3],[4] These waste products are then cleared from the injury site by the body’s circulatory system.

Basically, inflammation is the body’s natural response to injury or infection. So assuming ice does prevent inflammation, why would anyone want to do so? As Dr. Nick DiNubile, Editor in Chief of The Physician and Sportsmedicine, puts it “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?” [5] And assuming ice does prevent inflammation and your body’s inflammatory reaction is the wrong response to trauma, when you inevitably remove the ice, it seems logical that inflammation would still occur at that time. Icing an injury would at best delay inflammation since we have no reason to believe the body just gives up on its natural response after twenty minutes of icing.

Dr. Kelly Starrett discusses the fallacy of ice [6]

Furthermore, no clinical evidence exists to show ice actually works as claimed. A 2008 review of multiple studies concluded, “There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.” [7] A 2013 study showed no significant differences in soreness, swelling or inflammation between subjects who used an ice bath and subjects who received no treatment after a forty minute run. [8] And even Dr. Gabe Mirkin, who coined the RICE acronym in 1978, recently retracted his previous advice, saying, “It appears that both Ice and complete Rest may delay healing, instead of helping.” According to Mirkin, icing causes the constriction of blood vessels near the area of cooling. This constriction can delay (but not prevent) inflammation, and thus delay healing. In addition, decreased blood flow from icing may cause tissue death and even permanent nerve damage. [9]

We know inflammation plays a critical role in recovery. Therefore, external aid to the body’s natural healing process must assist this mechanism rather than hinder it. Inflammation results in dead cells and other waste products at the site of trauma, and under ideal conditions, the body removes this waste through muscle contractions provided by normal movement. So if your thighs are sore, walking or biking at a comfortable pace uses the pressure of muscular contraction to force waste products out of your thighs and facilitate recovery. If you have sprained your ankle and are unable to walk on it, compression and elevation can aid waste removal through the forces of pressure and gravity. Electrical stimulation that causes localized muscular contraction is another alternative to produce the same result. [10]

Thus, even without knowing the specifics of the inflammatory response, we should find enough questionable dogma in the myth of icing to cast doubt on this commonly accepted practice. In contrast, it makes little sense to blindly attempt to regulate a natural process like inflammation that has existed for over one million years without knowing what one hopes to accomplish in the bigger picture. Inflammation plays a crucial role in the body’s healing mechanism, so we have no reason to block inflammation in the case of acute injury, and there is no evidence to show icing does anything more than delay the inflammatory response. External assistance to recovery should focus on clearing the byproducts of inflammation when the body is unable to do so through its natural mechanisms.

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1. “Rest, Ice, Compression, and Elevation (RICE).” WebMD. 11 Oct. 2012. Online. 14 Jan. 2015. http://www.webmd.com/first-aid/tc/rest-ice-compression-and-elevation-rice-topic-overview.
2. Blakeney, Curt and Ziegler, Zig. “How to Ice an Injury Properly.” Active. Online. 14 Jan. 2015. http://www.active.com/articles/how-to-ice-an-injury-properly.
3. “Definition of Inflammatory response.” MedicineNet.com. 9 Oct. 2012. Online. 14 Jan. 2015. http://www.medicinenet.com/script/main/art.asp?articlekey=19510.
4. Henochowicz, Stuart I. “Immune Response.” MedlinePlus. 11 May 2014. Online. 14 Jan. 2015. http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm.
5. Starrett, Kelly. “People, We’ve Got to Stop Icing Injuries. We Were Wrong, Sooo Wrong.” Mobility WOD. 7 Aug. 2012. Online. 16 Jan. 2015. http://www.mobilitywod.com/2012/08/people-weve-got-to-stop-icing-we-were-wrong-sooo-wrong.
6. Starrett, 2012. Video from YouTube. Online. 20 Jan. 2015. https://www.youtube.com/watch?v=0UmJVgEWZu4.
7. Collins, N. “Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?” Emergency Medicine Journal. Feb. 2008, 25(2): p. 65-68. Online. 16 Jan. 2015. http://www.ncbi.nlm.nih.gov/pubmed/18212134.
8. Crystal N, Townson D, Cook S, LaRoche D. “Effect of cryotherapy on muscle recovery and inflammation following a bout of damaging exercise.” European Journal of Applied Physiology. 20 Jul 2013. Online. 16 Jan. 2015. http://www.ncbi.nlm.nih.gov/pubmed/23873339.
9. Mirkin, Gabe. “Why Ice Delays Recovery.” DrMirkin.com. 16 Mar. 2014. Online. 16 Jan. 2015. http://drmirkin.com/fitness/why-ice-delays-recovery.html.
10. Starrett, 2012. Mobility WOD.

2 thoughts on “The Fallacy of Ice

  1. The bottom line is that the people proposing icing injuries know nothing of the physiology of the temperature effect on the human body. Ice causes peripheral vasoconstriction of "the skin". Not internal tissue. The body does this to prevent hypothermia, we are homeotherms. You can not cool the internal tissue. After the nerves of the skin are cooled to the point they no longer control the vasoconstriction the skin flushes with blood. Not only does the human body try to reduce heat loss cooling blood prevents it from clotting, the proteins in the blood clotting cascade, fail to function at low temperature. It isn't just lymph fluid causing swelling there is bleeding, check the joint after a sprain, note the bruising. Icing was put out there by a doctor writing a book in the 1970's apparently with no background in environment physiology or research to back it up. Manufacturers and the red cross put it out there and now it's as if it's actual medical treatment. The Mayo Clinic used to advertise they based their medical treatment only on scientifically proven treatments. Even they put this out there like it's real a medical treatment. It's not, don't do it. Ice is good for venom bites, bee stings, immediately after they occur, it stops the venom, an enzyme a protein, from attacking the tissue, but only in the skin. Try a tourniquet and limb immersion in an ice bath until antivenin can be provided. Ice does not promote healing just the contrary.

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