To Ice or Not to Ice?

“How long should I ice after my workout?”

“Do you recommend ice or heat?”

“I’ve been trying to ice my back every night, but it just doesn’t seem to help.”

These are all common things I hear in my office on a weekly basis.

In an effort to avoid beating a dead horse here, I’m going to attempt to make this quick. If you’ve been around on my social media or website for any length of time, you likely already know how I feel about using ice as a modality to treat pain or injuries. I’ll go ahead and give away the ending: I don’t like it. 

But because I get asked a lot of questions in my office about it, I thought it deserved a blog post all of its own. 

First of all, if you’re someone who habitually ices any area of your body that hurts or is sore, know that your thought process is justified. Ice used to be a main protocol in treating acute injuries and was thought to decrease inflammation and speed healing. Most people are familiar with the acronym R.I.C.E. (rest, ice compression, elevation) for treating injuries. To this day, you can watch pretty much any televised sporting event and see an injured player get rushed to the sideline and get a bag of ice strapped to his/her appendage.

But we know better now. Recent evidence has now debunked the idea that ice speeds healing and, in fact, has actually suggested that ice may even DELAY healing. Whoops!

And we also know now that maybe some inflammation isn’t such a bad thing. In fact, it is a very necessary part of the healing process! Inflammation stimulates your body’s natural “healing cascade”, which brings white blood cells, oxygen, and other necessary components to the area. So to try to fight off this type of inflammation is really counterintuitive to the healing process. (Don’t mistake this for other types of chronic inflammation in the body, which is a conversation for a different day, but yes, is usually detrimental).

“But icing makes it feel better!” Sure—icing a painful area does have temporary analgesic (pain relieving) benefits, but should still be used minimally (or not at all).

This analgesic effect works mainly through a mechanism called the gate theory of pain. In simple terms, it means if you induce a non-painful stimulus (i.e., cold), to a painful area, that stimulus “closes” the nerve gates to the painful stimulus. In other words, your brain focuses on the non-painful stimulus versus the painful one, leading to a decreased pain experience or giving the perception of decreased pain. It is NOT because any healing is actually taking place. Fun fact: this is also why we tend to rub or hold an area when it hurts.

So let’s change our question from “How long should I ice?” to, “What should I do instead of ice?”

Glad you asked. 🙂

The best thing you can do for an injury (given that it’s not a broken bone or other emergent situation) is to keep it moving. Movement brings blood flow to the area, helps maintain mobility, and facilitates lymphatic drainage. And moving and loading these injured tissues is where the true remodeling and healing happens—not through repeated ice application and rest. (For a deeper dive on that, check out my blog post on rest prescription here).

And of course, if you’re battling an injury, it is always valuable and worthwhile to be evaluated by your local chiropractor or physical therapist to get a rehab plan that’s customized to your specific needs. The priority should always be true healing of the injury and returning to activity, not just managing the pain. If you’re interested in getting an injury evaluated or have further questions, I’m here to help! Feel free to reach out via the contact tab or book an appointment online.

Thanks for reading, friends. 🙂 Hope to see you soon.