Reasons You Shouldn't Use Ice On An Injury
Ice combined with NSAIDS hinders the healing process. Here's what to do instead:
Rest, Ice, Compression, and Elevation Is Outdated
If you read my last post about hydration you likely remember me saying that if something is said often enough people tend to believe it without question. When it comes to R.I.C.E healthcare is still dishing out this ineffective advice for injury care.
It’s been drilled into us, definitely for my entire 50 years, that if you get injured you need to ice the area. What’s wrong with applying ice to an injury?
Let’s stop and think about what the body does when you’re injured
The body’s natural healing process begins with inflammation. Inflammation also means circulation. Circulation brings in fresh blood, nutrients, and white blood cells - everything the body needs to repair the area. If inflammation is our body’s default mechanism for injury repair why are we shutting it down with ice?
Studies have shown that topical ice application not only delays the healing process it also lengthens the recovery process.
By decreasing the number of leucocytes and granulocytes as well as reducing macrophage infiltration following soft tissue injury, cryotherapy has been proved to reduce inflammation in different body parts. Nevertheless, although applying cold on the surface of the injured site may be effective in pain management or swelling, it could lengthen the recovery process. This is because, when we are injured, our body sends signals to our inflammatory cells (macrophages), which release the hormone-insulin-like growth factor (IGF-1). These factors initiate healing by killing damaged tissue. However, when ice is applied topically, the cold will act as a vasoconstrictor and impede the transport of those inflammatory chemicals and cells to the injured site. We may prevent the body’s natural release of IGF-1 and, therefore, delay the start of the healing and recovery process. A prolonged period of cold on the skin will lead to a reduction of the blood flow, resulting in tissue death or even permanent nerve damage.
It would heal faster if you did absolutely nothing, leaving the injury at room temperature, than if you applied ice to the area.
Should You Use Heat For An Injury?
Heat will encourage circulation in the area. From my own experiences with acute injuries I’ve been using heat instead of ice the last 5 or 6 years and things seem to heal faster. I also haven’t taken any NSAIDS since 2014. But I’ve also done a major dietary overhaul in that time too eliminating inflammatory foods (enter carnivore diet).
While the general consensus is to avoid heat right after an injury I don’t believe in absolutes.
Is the area visibly red and swollen?
Most research says applying heat when something is red and/or swollen will exacerbate the problem. Again, this hasn’t been my personal experience. I’ve jammed my share of toes, angered my meniscus, and bruised my shins while sparring in Taekwondo. Heat has been my go-to and I’ve never felt anything become worse.
I also think there’s a difference in a person’s physiology in that some people notice their skin turns red easily, whereas others like myself (olive complexion) don’t flush very easily. Does that mean one of us is more injured than the other because we flush more easily? I don’t think so. The human body is pretty universal in how it manages itself.
Does heat make it hurt more or less?
I believe this is the true test. If you apply heat and it makes the injury feel worse then remove the heat.
You could try lowering the temperature especially if you’re using a heating pad or hot water.
You could also revisit using heat in 24 hour increments. Wait a day, try heat again, if it still doesn’t feel relieving, wait 24 hours and try again.
You could also apply heat proximal to the injury - meaning somewhere between the injury and the torso. This will help circulation without being directly on the injury.
I wouldn’t add ice, instead I’d elevate the affected area to help the lymphatic system remove swelling. Allowing the swelling to dissipate makes room for fresh nutrients and white blood cells which will help accelerate recovery.
Maybe after the swelling has gone down from elevating the area maybe try applying heat once again.
How inflamed is your body?
Working at an injury clinic I see my share of patients who are systemically inflamed. Decades of eating the standard American diet has definitely taken a toll on the level of inflammation people are carrying before they’re ever injured. As you can imagine these people take longer to heal from an injury.
Self Massage For An Acute Injury
*NOTE: Before you do any massage you want to make sure the swollen area isn’t infected or hasn’t recently been bitten. You also want to healthy organ systems that are affected by increased circulation: heart, liver, kidneys, lungs, and lymphatic system.
The lymphatic system maintains fluid balance and quality. When it comes to injuries and infections the white blood cells contained within the lymphatic system helps destroy bacteria so they can be eliminated via the liver and kidneys. It also removes metabolic wastes via the same pathway. As these unwanted items are removed it creates space for fresh blood and nutrients to take their place.
For this work you want to work between the injured area and your body. Ex: if you injure your ankle you want to work from your leg / thigh towards your torso. If you injure your knee you want to work above the knee towards the torso.
Say you injure your knee and you massage the calf / shin area you’ll send more fluids towards an already swollen knee. Don’t do that.
The same rules apply to the arms.
Here’s what you do: lightly stroke the skin above (proximal) to the injury towards the torso. It doesn’t have to be deep, lighter is better. You can use lotion if you want but you don’t have to. Stroke the area for a couple of minutes and you should feel / see the swelling in the affected joint go down.
Keeping the affected joint elevated helps this process.
You can also move the joint above the injury. Say you injure your knee you would move your hip. If you injure your ankle you could move your knee and hip. The largest lymph nodes are in the joints so moving them helps stimulate lymphatic flow.
As the injured area becomes less sensitive to light touch you can progressively work closer to the injured area.
This kind of work is good for sprains and strains. For broken bones you want to make sure the area is set / secured before doing any massage work.
Reasons You Shouldn’t Take NSAIDs When You’re Injured
Cartilage covers your bones to protect your joints from friction. Chondrocytes are the cells that make cartilage. When these cells are healthy NSAIDs don’t affect them, however when you’re injured they hinder the body’s repair process.
In a systematic review looking at the affect of NSAIDs and how they affect cartilage they found:
We just discussed the benefits of inflammation and injury healing when it comes to ice, NSAIDs also shut down the inflammatory process. Pain is your body’s natural protective mechanism letting you know what’s too much activity for your injured area. When you pop a Tylenol or Advil you turn off that pain signaling. This could potentially cause you to use your affected muscles or joints beyond what they’re currently capable of.
Over use of NSAIDs has been shown to adversely affect the liver and kidneys. If you’re struggling with leaky gut or autoimmunity these types of meds aren’t recommended by medical professionals familiar with the autoimmune protocol. (Most aren’t.) Anything that adversely affects the lining of the intestines has the potential to trigger autoimmune symptoms. This is why I stopped taking them in 2014.
Alternatives To Ice and NSAIDs
Begin by reducing the level of systemic inflammation in your body via diet, lifestyle, and chemical exposures. Some of these won’t take effect immediately so it’s good to begin before your next injury.
Balance your Omega 3 and Omega 6 intake. Omega 6’s while necessary are inflammatory in abundance. The ideal ratio is 1:1 or 1:2. If you’re not paying attention to seed oil consumption this ratio can be 1:30 or higher.
Eat less sugar, sweeteners, food additives, and glyphosate
Eliminate grains from your diet
Exclude teflon, plastic, synthetic fabrics, phthalates, and toxic cleaning products
Try natural pain relief like: Arnica cream, epsom salt baths, magnesium glycinate, turmeric, and willow bark.
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References
Wang, Z. R., & Ni, G. X. (2021). Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?. World journal of clinical cases, 9(17), 4116–4122. https://doi.org/10.12998/wjcc.v9.i17.4116
Merkely, G., Chisari, E., Lola Rosso, C., & Lattermann, C. (2021). Do Nonsteroidal Anti-Inflammatory Drugs Have a Deleterious Effect on Cartilage Repair? A Systematic Review. Cartilage, 13(1_suppl), 326S–341S. https://doi.org/10.1177/1947603519855770