DR. ERIN BOYNTON

In recent years, there has been some controversy regarding the age-old habit of icing injuries.  Until recently, whenever we had a sore muscle, joint, or tendon, we were told to put ice on the area. Remember RICE? Rest, Ice, Compression and Elevation?  Well, some people have called into question the practice of icing and become somewhat alarmist, suggesting that ice could actually cause damage to our body. 

As an orthopaedic surgeon, sports physician, and athlete, I have prescribed and used ice regularly.  The purpose of ice is not only to act as an analgesic (pain reliever), but help decrease swelling and, in my experience, speed recovery.  I would tell my patients to ice their shoulder or knee right after surgery to help control pain and swelling; despite some published articles to the contrary, I still do.

A recent article in the NY Times, “Ice for Sore Muscles? Think Again” suggests that icing may not be so good for us or our muscles.   Ice for Sore Muscles? Think Again. – The New York Times (nytimes.com). 

So what do I think of this article?  First, let’s make sure that we are comparing apples to apples.  There are different uses for ice after activity.  Ice can be used to: 

1. Improve muscle recovery/performance by decreasing delayed-onset muscle soreness and accelerating recovery so that we are ready to go for our next 3-hour match in the heat.

2. Prevent swelling and control pain of an acutely injured joint, e.g., an ankle sprain.

3. Prevent inflammation/injury of a chronically sore muscle or joint.

The Times article discusses acute muscle tears and delayed onset muscle soreness, which in essence is comparing apples to oranges.  It is important to recognize that the scientific articles quoted in the Times would be considered low-quality scientific evidence.  For example, the first study looked at acute muscle tears in the gastrocnemius muscle (calf muscle).  The study investigators examined 19 patients with a calf muscle injury and concluded that ice did not provide any benefit compared to patients who did not ice their calf injury as there was no difference in time to return to work.  This is an extremely small number of patients, and the outcome measurement did not look at range of motion, strength or overall pain.  Finally, the study did not capture all the patients with injuries to the calf, and there was no discussion of other treatments that may have been combined with ice.  This study was too small and incomplete to lead me to change my clinical practice.  I will still recommend ice for acute muscle tears. 

The major study discussed in the article examined muscle injury after exercise in mice.  This reported a decrease of muscle regeneration in the group of mice that received ice treatment compared to the group that did not.  The protocol used to induce muscle injury in the mice was severe, resulting in not simply delayed-onset muscle soreness, but actual muscle tearing.  Therefore, the conclusions are somewhat misleading and not applicable to the human condition.  I will still recommend an ice bath post-strenuous physical exertion to aid muscle recovery. 

 If you would like to hear my thoughts on the literature and the bad name that ice has been getting lately, I recently reviewed the use of ice to treat acute injuries in a YouTube presentation which you can find at the following link, https://youtu.be/NPQN4SP7Tko.

 I personally will continue to use cold or ice in the following scenarios:

1. After I have played a long match in extreme heat, I will hit the showers, and yes a cold one, spraying down my legs for 30 sec on and 10 secs off for 2 minutes to help cool my body and aid muscle recovery.

2. I will ice a nagging tendon, muscle or joint for 15 minutes after a game as an analgesic and to help prevent inflammation; I always follow up icing with gentle isometrics.

3. Any acute injury where there is swelling, I will ice for 48 hours minimum for 15 min 3 times per day.

From both my clinical experience with thousands of patients and my personal experience with the cold, I still vote yes to ice.  The most important thing is for you to listen to your body.  Some people love ice, and others do not.  If it feels right, and it feels good for your body, then go for it. If it does not, then ice...the ice.