Stop icing your sore muscles

June 16, 2015

Earlier I posted some goofy photos to Twitter showing me applying severe compression to my lower legs after some strenuous running practice. Accompanying the photos was a bold statement, “Compression > ice, in almost every situation.” This sparked some interest, so allow me to explain.

If you’ve spent much time in athletic fields, you may have heard of the mnemonic RICE: rest, ice, compression, elevation. The term was originally coined by Dr. Gabe Mirkin, who rescinded the recommendation in 2014 with an article called Why Ice Delays Recovery. It’s worth reading; when an authority declares something as the best and then later retracts that advice, you know something’s up. He goes into plenty of gruesome detail in the article, and cites plenty of sources, so realize that my post will be purposefully brief and simplistic in explanation. If you really want to understand more, go searching. Mirkin’s article is a fantastic overview.

“We all know” you’re supposed to put ice on something when it hurts or is swollen, just like “we all know” that whole grains are good for you and you shouldn’t squat below parallel. (I’m being sarcastic.) The chief issues with icing to me are that it impairs blood flow, the lymphatic system, and principally the inflammatory response. Most of us think of inflammation (and swelling, etc.) as being bad—the NSAID industry is booming, and we all seem to take ibuprofen at the first sign of any discomfort at all. The opposite is true: the inflammatory response and immune cells associated with it are critical in healing damaged tissues. Anyone who has passed a basic human physiology class can tell you that inflammation is an integral part of the healing process. Let me be clear: slowing down inflammation slows down healing.

So I’ve kicked the NSAIDs and I’ve kicked the ice. Both can be resorted to during severe, acute bouts of pain. Indeed, ice works well if something needs to be numbed because it’s that bad. But it’s not that bad, and that’s not what we’re talking about here. We’re discussing your achy knees after a long, hard run, or your back after mowing the lawn. Icing these pains and then going out running the next day and doing it all over again is akin to stubbing your toe on the same table every day. Just move the damn table, people.

If you are severely injured, get medical attention. Ice it if it’s that bad. You could even take pain medication. But to treat sore muscles, tendons, ligaments, etc., I use movement, compression, and elevation.

Move what you can, when you can. If it’s sketchy, you probably shouldn’t do it, but resist the urge to just lay down and assume it’ll all get better. When you do move, try not to limp. The goal should be to use and move your muscles and the associated tissues, get blood flowing and lymphatics working, and expedite healing.

“Compression” can range from compression socks to voodoo floss bands (I hate the name, but they’re ridiculously effective, and they’re what I prefer.) The act of compression helps with a couple of things: prevention of swelling, and the facilitation of the lymphatic clearing of extracellular waste, blood flow, tissue perfusion, and so on.

Elevation works alongside compression via similar mechanisms, encouraging the lymphatic system via the assistance of gravity, and again preventing swelling.

Rest, in general, would be discouraged, since movement facilitates a large part of the healing process. Certainly, take a day off from the gym, lest you risk making the injury worse, and don’t flex a broken bone. But if your ankle hurts, I would expect you to walk on it throughout the day as best as possible. If it’s your knee or something, some good bodyweight squats might be in order.

Ice, however, is out. Do you really think that your body’s natural inflammatory response is a mistake?