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Icing, what does it do?

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For injuries, it’s always advised RICE. That is rest, ice...

It sure feels good after 15 minutes of icing. But I wonder does it just numb the area so the pain & ache is less bothersome?

Or Does it do any real benefit beyond that?
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Anti-inflammatory, perhaps?
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pam w wrote:
Anti-inflammatory, perhaps?


This. To reduce swelling but you've got to get on early
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@abc, It constricts the blood supply to the injuries and thereby reduces swelling/inflamation. Not sure it does much to numb the area.
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@foxtrotzulu, oh it does. When I smashed my tibial plateau I instinctively drew my knee up to my chest. I iced it ..a lot...and was able to straighten my leg enough to try and stand on it. Then it was painful Laughing
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foxtrotzulu wrote:
@abc, It constricts the blood supply to the injuries and thereby reduces swelling/inflamation. Not sure it does much to numb the area.


Oh boy numbing the pain with ice is like heaven after a knee op!
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as @foxtrotzulu, says reduces inflammation. As soon as possible, max 20minutes at a time. C is for compression, E for elevation.
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abc wrote:
For injuries, it’s always advised RICE. That is rest, ice...

It sure feels good after 15 minutes of icing. But I wonder does it just numb the area so the pain & ache is less bothersome?

Or Does it do any real benefit beyond that?


When you get internal bleeding from muscle tears, putting ice on these areas will reduce blood flow and slow the internal bleeding and allow clotting to occur in the blood vessels. So the ice on an injury is primarily to slow the internal bleeding.

Beyond that (first 48 hours after injury), if there is less blood in the area which has clotted, it will be less painful to remove the clotted and congealed blood around the muscle fibres. Movement will therefore be easier, as there will be less of a blood mass constricting muscle movement.

The body will remove the clotted blood in its own time, but by applying ice immediately after muscle tears it will allow you to heal faster and less painfully.

Applying ice and then heat to an area alternatively, makes the blood vessels contract and then expand. It makes them more flexible, and consequently improves blood flow.

This is the theory.

Consequently, applying ice a long time after the injury will not really help much as the blood will have clotted by then. It is massage and heat, and stretching, which will then remove the clotted blood in the muscle fibres.


Last edited by You'll get to see more forums and be part of the best ski club on the net. on Fri 19-02-21 13:11; edited 1 time in total
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I'm not sure if it's still advised. In old school days a bag of snow and elevation were standard, which gave R and I, with E being easy to obtain.
Alternation of cold and warm were supposed to be a good thing.

However more recently mostly I think people just quaff Ibuprofen, of which I'm a fan.

For clotted blood, physio people have machines which make that magically disappear, if you pay them enough.
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holidayloverxx wrote:
...When I smashed my tibial plateau I instinctively drew my knee up to my chest. I iced it ... Laughing


Cold heart? Toofy Grin
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philwig wrote:
I'm not sure if it's still advised. In old school days a bag of snow and elevation were standard, which gave R and I, with E being
easy to obtain.

Yes, it's still advised.

In fact, it's advised beyond just the post injury period. It's now advised to do that even during the recovery/PT period too.

Quote:
Alternation of cold and warm were supposed to be a good thing.

Heard that from the grapevine. But haven't seen it advised on official medical sources.

Quote:
However more recently mostly I think people just quaff Ibuprofen, of which I'm a fan.

I'm not a fan of that. Does a number to my stomach

Quote:
For clotted blood, physio people have machines which make that magically disappear, if you pay them enough.

I've never heard of that? What's the machine called?
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@abc, my understanding is that it reduces swelling (and maybe pain). There seems to be a lot of doubt as to whether it makes much difference to recovery in the longer term
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Having spent hours, in the middle of the night, sitting with ice backs across my back after I injured myself falling at table tennis a year ago I can attest that ice certainly numbs pain. That was as well as, not instead of, ibuprofen, paracetamol and codeine. Whether it made any difference to recovery I don't know, but I'd not have wanted to be without those welcome hours of pain relief. The ice was more effective than the drugs.
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Rest
Ice
Compression
Elevation

I thought I read somewhere recently that paracetemol does't actually work. In my experence tea is just as effective at pain releif as ibuprofen and all other over the counter medicines.
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It reduces inflammation. What you need to ask if that's a good thing or not. There is more research coming out that taking anti-inflammatory drugs (e.g. ibuprofen) actually slows healing. Inflammation is a key signal to the body to adapt/recover. I think ibuprofen blunting the adaptations of exercise on muscles is going to be a hot topic in sports science over the next few years.

My personal opinion now is to only take anti-inflammatory drugs or ice in two situations:
- extreme pain
- repeated efforts (i.e. if I was doing some hut to hut traverse and was sore following day 1 but needed to complete the trip).
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Many athletes take ice baths after long endurance exercise. In the summer time, I might sit in the river after a long run (which is pretty cold even in summer time). It certainly seems to help at the time, although in order to prove its effectiveness compared to a placebo you would need some way of comparing "inflammation levels" empirically by taking blood samples. I suspect such studies have been conducted for drugs such as ibuprofen, however comparing these to sitting on ice or having some green tea is not going to be a high priority for those paying for the study.
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Quote:

Many athletes take ice baths after long endurance exercise.


Athletes are only taking ice baths when absolutely necessary. I.e. a cricket fast bowler who has to play back to back days will use them so they can perform at a top level. For general training ice baths defeat the point as they decrease adaptations, the whole goal.
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There are many other things you can do to reduce inflammation in general. (other than taking drugs)

Avoid:
1. do not drink alcohol or smoke tobacco
2. avoid sugars and refined carbohydrates
3. avoid saturated fats and fried foods and processed meats such as sausages and bacon

eat and drink:
4. have tumeric, ginger, black pepper, olive oil and tomatoes
5. oily fish such as salmon, sardines, mackeral
6. eat berries such as blueberries, strawberries, raspberries etc
7. get a tin of pitted cherries and put them in a blender, and drink
8. eat broccoli, peppers, chillies and mushrooms
9 drink green tea and eat dark chocolate and grapes
10. increase hydration

As inflammation is multi-factorial it is very difficult to extract which precise effects are the strongest factors (particularly when you read such nonsence on forums and websites). Until such a detailed study is compiled to extract the most significant factors, like beetroot, just kitchen sink all the good stuff and bin all the bad stuff.

Sounds a bit like a Mediterranean diet but that is not precise enough for me....

Probiotics and high fibre diets are also thought to reduce inflammation. Being at the right weight for your height is also a way to reduce inflammation, as obesity can increase inflammation and cause disease.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579563/

my summary of this detailed study into inflammation suggests that the answer is not known precisely, although there is a lot of detail.
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@bigtipper that is chronic systematic inflammation. I think here we are mostly talking about acute localised (i.e. injury or doms). Even then it's not clear for example this study suggested carbs wether high GI (i.e. sugar) had little effect on inflammation https://pubmed.ncbi.nlm.nih.gov/24787494/ The one thing that seems consistent is that losing weight lowers blood markers of inflammation.

I'm not aware of any research that suggests acute localised inflammation is in any way bad. In fact exercise is one of the best examples of localised acute inflammation and is overwhelmingly positive.
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I get that localised inflammation differs from general body inflammation. However, does high general body inflammation make localised inflammation worse and more likely?

In other words, by being less inflamed generally, local inflammation will be less of an issue!
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@Bigtipper, but @boarder2020 raised a question if reducing inflammation is such a good thing in the case of injury? Isn't inflammation the very mechanism for the body to repair the damaged tissues?
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I'm just not sure local inflammation is an issue though? It's either due to injury so necessary for optimum healing. Or its due to soreness following exercise which again is necessary for optimum adaptation. The exception being when you have to perform back to back days and performance is more important than adaptation (think tour de France rider or someone doing a multi-day ski tour).

As for systematic inflammation I think you hot the nail on the head when you say
Quote:

it is very difficult to extract which precise effects are the strongest factors

Be at a healthy weight (this is the most important point), eat a healthy diet (you don't need to be an expert in nutrition to know what's generally "good" and "bad"), try to minimise stress, exercise regularly etc. It's all the normal stuff. Inflammation will take care of itself.
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@abc, I suppose it depends on how much damage there is and how effective your immune system is. If there is too much swelling and inflammation for a minor injury then it might make sense to moderate an over enthusiatic immune response.

On the other hand if you are immunocompromised, and do not have a good immune response, then it may not be a good idea to suppress such a response.

If you know that the response is unlikely to be bacterial, as in the case of a muscle tear, then much of the immune response is overkill. You really just want the damaged blood vessels to be clotted and healed, and you do no need all the rest of the bodys response. The body does not know what it is dealing with, and so responds with its standard response.

If RICE was not effective in dealing with minor strains or sprains we would soon know about it! From a practical point of view, if you found it had no effect you would not bother doing it. The question is does it do any harm, and in most cases the answer is unlikely.
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@Bigtipper, I'm not sure that's correct. I don't think inflammation is just to fight off infection.

Anyway, we're going into wild speculation now. I guess it's not really clear even for the medical people. So I'm just going to assume it feels good and probably does no harm.
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Quote:

If RICE was not effective in dealing with minor strains or sprains we would soon know about it! From a practical point of view, if you found it had no effect you would not bother doing it. The question is does it do any harm, and in most cases the answer is unlikely.


How would we know? If you get a sprain and follow RICE you have zero idea if you healed any quicker than if you had just done nothing. There is little (if any) hard evidence that anti inflammatory drugs increase recovery. What they can do is reduce pain that makes us feel better but less pain/inflammation doesn't equal better recovery.

On the other hand there is evidence that NSAIDs may be detrimental to healing of bones and tendons. The jury is still out on muscle injuries a few studies found NSAIDs were detrimental to healing,others found no difference.

Based on the science it seems like a no brainer to avoid anything that reduces inflammation. At best you get similar healing to not reducing inflammation, at the risk of potentially decreasing healing. For pain take something like paracetamol.

Quote:

The question is does it do any harm, and in most cases the answer is unlikely.


The bar is set very low if something is worthwhile doing just because it doesn't cause harm! The question should be does it help? Which there seems to be little evidence for. I'd say there is compelling evidence that it does cause "harm" (slower healing) in bone and tendons. While the jury is still out on muscle injuries there seems to be zero benefit and potential risk.
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Rest
Ice
Compression
Elevation

All help to reduce inflammation. The inflammation itself can exacerbate the injury. Ice & Compression mechanically reduce blood flow to the injury site. The Elevation element means keep the injury above the heart to help drain the blood and lymph away using gravity.
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boarder2020 wrote:

On the other hand there is evidence that NSAIDs may be detrimental to healing of bones and tendons. The jury is still out on muscle injuries a few studies found NSAIDs were detrimental to healing,others found no difference.

I think the jury is still out for all of them, even for bones and tendons.

There're a few studies found NSAIDS are "correlated" to worse outcome in bone healing. But it wasn't clear if the NSAIDS was causing the slow healing. Or that the healing was slow and the fracture site painful, therefore patients use NSAIDS to deal with the pain.

There were very limited studies using placebos. The results there were mixed. Some found no difference. Some found some difference but even there, it wasn't conclusive.
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@abc it's always going to be difficult to definitively measure. Huge issues with quantifying injury and measuring outcomes. I did my PhD in a musculoskeletal area where normal practice for quantifying rehabilitation outcome was a questionnaire, which have a whole host of problems too.

Even if you don't think there is enough evidence to be convinced reducing inflammation can lead to slower healing, there seems to be even less evidence that reducing inflammation leads to quicker recovery. So the question becomes why try to reduce inflammation, where is the upside? If it's just about relieving pain there are other options that don't reduce inflammation.

There should be a paper coming out of Karolinska institute soon proposing the mechanism for why nsaids decrease training effect.
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https://www.nhs.uk/conditions/sports-injuries/treatment/

https://www1.racgp.org.au/newsgp/clinical/is-it-time-to-rethink-rice-for-soft-tissue-injurie#:~:text=

So the NHS recommends PRICE but there is little evidence to support its use, and it could be a healing inhibiter. I will keep my mind open on this, and use it sparingly.
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Quote:

https://www1.racgp.org.au/newsgp/clinical/is-it-time-to-rethink-rice-for-soft-tissue-injurie#:~:text=


The guy arguing for ice here actually makes a good point. Let's say you sprain your ankle and doing some kind of anti-inflammatory procedure (ice, drugs) means you can stay walking as opposed to someone that is unable to walk for numerous days due to inflammation. There is an argument to be made that it will result in a better overall outcome. Anti-inflammatory procedures definitely have their place, but I think it is more nuanced than simply icing everything all the time which can be detrimental.

There are quite a lot of examples like this where something was purposed and we've just almost blindly stuck with it. Static stretching before sport is a great example where it was just accepted for years. Now research suggests it probably doesn't decrease risk of injury and likely decreases performance.
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Yeah, I only bother doing dynamic stretching of my hamstrings before a run after a warm up. However, I do some static stretching and yoga positions afterwards. I do not get many injuries these days. Most of my previous injuries could have been related to over stretching doing static stretches, which were not appropriate for my body and age.

Foam rolling is very effective though, although someday someone will say it is not good for me.
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Quote:

The guy arguing for ice here actually makes a good point. Let's say you sprain your ankle and doing some kind of anti-inflammatory procedure (ice, drugs) means you can stay walking as opposed to someone that is unable to walk for numerous days due to inflammation. There is an argument to be made that it will result in a better overall outcome. Anti-inflammatory procedures definitely have their place, but I think it is more nuanced than simply icing everything all the time which can be detrimental.

Sounds to me it's just a matter of "everything in moderation"?

Too much inflammation is likely not helpful. So calm it down with ice/drugs. But excessive icing/drug to remove all inflammation likely slows down healing.

That said, I'm not sure icing/drug can actually remove "all" inflammation? My past experience was, icing/NSAID only reduces swelling, but really doesn't completely prevent/eliminate it. One would have to do A LOT of icing and drug to achieve that! So I'm a little doubtful of the harm ice/drug may cause.
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Quote:

Too much inflammation is likely not helpful. So calm it down with ice/drugs. But excessive icing/drug to remove all inflammation likely slows down healing.


I still don't buy too much inflammation is bad. In nuanced cases you might have an argument that reducing inflammation leads to an overall better outcome. For example in the sprained ankle case above being able to minimise inflammation to maintain weight bearing activity definitely offers some benefits, but you are possibly trading them for slower recovery of the actual injury.

There is also the argument that even if you take ibuprofen to allow exercise (which would be considered a positive outcome), the ibuprofen will take away some of the benefits of training anyway. For example there is an animal study showing that ibuprofen cancels running-distance-dependent adaptations of muscle. I.e. it may help you run longer, but it doesn't translate to further improvements.

Even for a medical professional it would be almost impossible to predict the alternative outcomes with and without ice. Let alone try to quantify them. So for those of us without specialist knowledge it seems like the default option should be to avoid trying to reduce inflammation for minor injuries and soreness. Accept it is just a natural part of the healing cycle, and decreasing it could have negative affects. If you are in a position where you have massive inflammation you will probably be in the hands of a medical professional anyway who can make the decision for you.


Quote:

I'm not sure icing/drug can actually remove "all" inflammation?...So I'm a little doubtful of the harm ice/drug may cause.


I don't know how much inflammation you have to take away to have negative effects. This study (https://pubmed.ncbi.nlm.nih.gov/11832356/) looked at muscle synthesis following exercise. In the control group there was a 75% increase following exercise (what you might expect to see, training effect). When taking normal doses of ibuprofen there was no significant increase in muscle protein synthesis following exercise. It's enough to suggest normal doses of ibuprofen have a pretty significant affect.
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[quote="Physiojen"]
Quote:

I still don't buy too much inflammation is bad...

Even for a medical professional it would be almost impossible to predict the alternative outcomes with and without ice. Let alone try to quantify them. So for those of us without specialist knowledge it seems like the default option should be to avoid trying to reduce inflammation for minor injuries and soreness. Accept it is just a natural part of the healing cycle, and decreasing it could have negative affects...


I'm confused. As a "qualified physio" are you suggesting ignoring the commonly recognised advice to apply ice? Every physio and Dr I've seen regarding sports injuries has proscribed ice/RICE
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Quote:

I'm confused. As a "qualified physio" are you suggesting ignoring the commonly recognised advice to apply ice? Every physio and Dr I've seen regarding sports injuries has proscribed ice/RICE


RICE is very outdated. In fact in 2014 Dr Mirkin who coined the term RICE retracted ice and rest from his original protocol as he believed there was enough evidence to debunk both. In 2019 the British journal of sports medicine put forward PEACE & LOVE (Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularisation and Exercise) which is what any Dr or physio up to date with the research should be using.

https://bjsm.bmj.com/content/54/2/72

If you have enough swelling where anti-inflammatory is necessary you will probably be in the hands of a medical professional who will advise you. For minor injuries you shouldn't ice.
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Physiojen wrote:

If you have enough swelling where anti-inflammatory is necessary you will probably be in the hands of a medical professional who will advise you. For minor injuries you shouldn't ice.

Most, if not all, of the "medical professional" I've had contact with for the various injuries in the past few years advised icing. Are you suggesting all of them are out of date?

(I've also had a couple of surgeries. ALL post-op instructions includes anti-inflammatory drugs)
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Quote:

Most, if not all, of the "medical professional" I've had contact with for the various injuries in the past few years advised icing. Are you suggesting all of them are out of date?


The RICE concept is very outdated. The use of NSAIDs has been questioned for a long time - here is an example from the BMJ published in 1998 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113091/. Even the creator of RICE has said ice and rest are not beneficial to recovery. This is the most up to date advice https://bjsm.bmj.com/content/54/2/72 - which you will see suggests avoiding anti-inflammatory procedures. If that is not enough to convince you icing it's outdated, I don't know what more I can do!

Of course I am speaking from a general point of view. There are nuances. For example when there is huge amounts of inflammation, reducing inflammation can be beneficial - perhaps the case with your surgeries. I've personally only had one case where I felt 100% confident NSAIDs and ice was the best option (car accident, shoulder dislocation, too much inflammation to put the shoulder back in - was clear the sooner we could reduce inflammation get the shoulder back in and start rehab was the best option).
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