No ice ice baby?

“Somewhere along the line, the concept that ice facilitates healing became conventional wisdom. Sorry, that wisdom is wrong." 

Joshua J. Stone has so many letters after his name, his diplomas could probably double as wallpaper. He’s an MA, ATC, NASM-CPT, CES, PES, and FNS…but, other than FNS (which means Fitness Nutrition Specialist), we didn’t examine every impressive credential. However, we did learn that he’s a former sports medicine program manager for the National Academy of Sports Medicine who, he says, has provided “rehabilitation and performance training for many Olympic and pro athletes.” 

Joshua Stone recently blogged “Why Ice and Anti-inflammatory Medication is NOT the Answer,” about the overuse of cryotherapy, or ice for injuries. He posted a similar subject back in July. “The controversy surrounding the topic,” he later wrote, made his July post “one of the most popular blogs I’ve written” — which is why we’re presenting his latest comments here. This is not our recommendation, folks, but just one person’s opinion. You should always consult your doctor for any injuries you have. 

According to Stone, “Ice, compression, elevation and NSAIDs [which stands for Non-Steroidal Anti-Inflammatory Drugs, such as aspirin, ibuprofen and naprosyn] are so commonplace that suggesting otherwise is laughable to most. Enter an Athletic Training Room or Physical Therapy Clinic: nearly all clients are receiving some type of anti-inflammatory treatment (ice, compression, massage, NSAIDs, biophysical modalities, etc). I evaluated a client the other day and asked what are you doing currently – ‘Well, I am taking anti-inflammatories and icing.’” But Stone doesn’t agree this therapy is always best. “Why do you want to get rid of inflammation and swelling?” he asks, and he asks it for both long-term cases, as occurs with arthritis, as well as for acute [sudden] injuries.

Stone quotes Dr. Nick DiNubile, The Physician and Sports Medicine Journal’s editor-in-chief, who “once posed this question: ‘Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?’ Much like a fever, inflammation increases body temperature to kill off foreign invaders; inflammation is the first physiological process to the repair and remodeling of tissue. Inflammation, repair, and remodel. You cannot have tissue repair or remodeling without inflammation.” 

Pointing to the results of a study at the Cleveland Clinic, Stone notes that cells in damaged muscles automatically respond to acute injury through engulfing and destroying foreign bodies, such as bacteria, that could threaten the organism as it heals. A sudden injury also  causes muscle cells “to produce a high-level of Insulin-like growth factor, which is required for muscle regeneration” and prevention of muscle cell death. He notes a 2010 study by two researchers from the department of Biochemistry and Molecular Biology at the University of Medicine and Dentistry, which concluded that “‘overwhelmingly, NSAIDs inhibit or delay fracture healing.’ And you want to stop this critical process of healing by applying ice, because inflammation is ‘bad’?,” he asks.

“Somewhere along the line,” Stone explains, “the concept that ice facilitates healing became conventional wisdom. Sorry, that wisdom is wrong. I had someone tell me the other day, 'We need to ice, because we need to get the swelling out.' Really? Does ice facilitate movement of fluid out of the injured area? No, it does not.”

But the human lymphatic system, Stone says, does. “’The lymphatic system is a ‘scavenger’ system that removes excess fluid, protein molecules, debris, and other matter from the tissue spaces.’” Swelling tells the lymphatic system to go to work, a natural control that’s important to maintaining the body’s equilibrium.

“If swelling is accumulated,” Stone says, “it is not because there is excessive swelling, rather it is because lymphatic drainage is slowed. The thought that ice application increases lymphatic flow to remove debris makes no sense.” He offers this analogy by the author of “Iced! The Illusionary Treatment,” Gary Reinl: “Take two tubes of toothpaste, one is under ice for 20 minutes, the other is warmed to 99 degrees. In which tube will the toothpaste flow fastest? It does not take an advanced physics degree to know that answer.

“What might surprise you,” he continues, “is that ice actually reverses lymphatic drainage and pushes fluid back” into areas of injured tissue. In fact, a 1986 study showed that when ice is applied to a body part for a prolonged period of time; it affects the lymphatic system in such a way as to actually increase the amount of local swelling and slow the body’s removal of unwanted cell debris.

Stone sure isn’t crazy about ice, so it’s no surprise that his view on RICE (Rest, Ice, Compression, Elevation) is that it, too, “is bogus.” In his opinion, the “I” for ice is not its only problem: “Rest is not the answer. In fact rest causes tissue to waste.”  Stone asserts that the evidence shows that injuries heal better through exercise or another form of movement that actually promotes protein, gene, and collagen formation.

“I ask health care professionals to do one thing, just try it,” suggests Stone. “Pick one client with chronic musculoskeletal pain, skip the ice, skip the NSAIDs and try to use light exercise as a repair stimulus. Then, try skipping the ice on a client with an acute mild injury. The outcomes might surprise you.”