Tuesday 16 August 2016

The Icing Controversy

So you're on your Sunday morning jog and you step on a tree root, causing your foot to twist at a delightful 80 degree angle and make a decadent, stomach-wrenching, "pop". Congratulations! You've sprained your ankle. Time to rest, ice, elevate, and compress that sunova'gun!

But hold on! Have you heard the most recent controversy in injury care? Ice, the time-honoured, tried-and-true method of managing your aches and pains, is under new scrutiny on how effective it really is for us. And what's worse, it turns out that the research that we need to help solve the debate is conflicting at best.

What Happens During Injury and Icing?

When you sustain an injury, your body goes through the same reaction every time, varying in degree based on severity. Your blood vessels dilate, fluid moves from the blood to the tissue, and metabolites are sent to the area to try and protect and heal. The problems arise when too much fluid and debris accumulates in the area, resulting in excessive swelling. From that, we get an effect known as "secondary hypoxic injury", which is the continued death of the body's tissue when blood flow is restricted by the swelling. In the end, the afflicted area is more damaged than the initial injury itself caused.

In contrast to this, ice essentially counters the inflammation response. It causes blood vessels to constrict, metabolic activity to slow down, and the swelling can be minimized before it even occurs. And of course, there's the lovely effect of reduced pain.

But What About Recovery?

This is where we run into the controversy. Yes, excessive inflammation and swelling is a cause for increased damage and recovery time. However, we need to stop and think about the fact that inflammation is also the method in which our body heals itself. That blood vessel dilation and fluid flow into the tissue is the way in which nutrients are sent to the area for recovery. By restricting this flow, are we impeding the recovery process?

The answer: Maybe?

Like I said, the research is still conflicting if it exists at all. Definitely, the risk of that secondary hypoxic injury is real, and it seems reasonable that it should be controlled. However, past that acute phase, is there any real need for cold therapy when we, in fact, require those inflammatory reactions in order to trigger tissue healing?

I won't try to pin down an exact answer at this point. There are people smarter than me that I'll leave that job up to. In the meantime, I'm playing it safe in the middle ground. When I see someone sustain an acute injury, I typically recommend ice for up to the first 24 hours. Past that, either no temperature change at all or even the application of heat is what I'll suggest in order to potentiate the inflammatory healing effect without such a risk of an exaggerated swelling response. (And of course, continued movement, the best medicine.)

Take some time to think about it.

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