Updated: Apr 1, 2019
By Dr. Lisa Goodman, DC, CCSP, CACCP
Who knew that the “I” in PRICE would be a topic of so much controversy of late. You may not have heard about it yet, but several theories regarding whether or not to ice have surfaced in the last few years. Of course PRICE is an acronym we typically apply after injury: Protect, Rest, Ice, Compress, Elevate. And by injury we typically think of something rather traumatic such as an ankle sprain or lower back strain. And the purpose (in general) of ice all of these years is to quickly reduce inflammation which also reduces pain. I recently had the pleasure of hearing all of the current research on Cryotherapy as presented by Douglas Andersen, DC, DACBSP, CCN at the American Chiropractic Board of Sports Physicians symposium last weekend. He too seemed surprised by the controversy, but we both have an open mind…
Thus enter the controversy. Most of it stems from the theory that reducing inflammation may reduce healing time. Inflammation, after all is the body’s normal response to injury. During the inflammatory process, your immune system acts fast to stop further damage and grossly repair the affected area. Eventually, the damaged tissue is remodeled, but during the first two days after injury, the onslaught of fluids can result in swelling, bruising, spasms, pain all of which can be severe. Many in physical medicine also recognize that while the inflammatory process is imperative to healing injury, it is possible that the process can be overkill for the given injury. I see this much like a severe reaction to a bee sting…just because you’re body may have a severe histamine response to a bee sting doesn’t mean that it is good for the healing or that it shouldn’t be addressed. See my point?
So traumatic injury is when we typically ice, but there are many other times when we apply ice. For example, after routine exercise (to prevent muscle soreness and speed recovery), after long or hard exercise (ie. ice bath after a marathon), between competitions on the same day, after chiropractic or manual therapy treatment or surgery. All of the above can cause varying degrees of swelling.
So given current research, clinical experience and common sense, here are my recommendations that are somewhat situation specific:
Acute Injury (or surgery): YES, always. 15 minutes every two hours for the first two days.
After Chiropractic / Manual Therapy treatment: YES. However, in this case we DO want inflammation to help with healing, so I recommend icing at bed time. This will decrease inflammation in the morning, while allowing it work the day prior.
After intense exercise: This is situational. If you feel that you have sustained an injury or increased your body heat during the event, then YES.
After routine exercise: NO. However, while you don’t have to, it probably won’t hurt if you do.
Between or before competition: NO. It probably isn’t a great idea to severely cool down muscle tissue prior to an athletic event. In most cases muscle and ligament tissue responds better if warm. If you have sustained an injury that needs attention between events, seek medical care and determine if continuing is possible.
One really interesting thing to contemplate…although the benefits and effectiveness of ice are currently being debated, I have not seen any compelling evidence that it causes any damage (when used properly). So when in doubt, use it.
How to Ice properly:
When using an ice pack or back of ice, do not place directly on the skin. Always use a thin barrier such as a bandana or pillow case. Compressing the ice pack works best (wrap with plastic wrap or a bandana). Use for no longer than 15 minutes or it can cause nerve damage and overheating of the tissue (Van’t Hoff Factor). Use only once per hour.
When icing an extremity, for the best results, submerge in an ice water bath for 10-13 minutes. Start with a bowl or bucket of cold water, insert extremity, add ice to keep it cold.
So what about heat?
Given the description above, we obviously do not want to use heat after acute, traumatic injury. Heat may be indicated for chronic, sore or stiff muscles and in the case of arthritis. Heat encourages blood flow to an area and may bring nutrients and fluids to areas that need them. When using heat, follow the same rule of thumb, 15 minutes no more than once per hour. Moist heat works best. Please please please, do not fall asleep on a heating pad. You may not be able to walk in the morning.
So in my opinion, the ice crisis needs to chill. If it works for you, use it. If not, don’t worry about it.
If you have any questions, feel free to stop by our practice in Washington Park, Denver, CO. You can also email me at firstname.lastname@example.org
Washington Park Chiropractic is the only practice in Denver, Colorado specializing in Sports Chiropractic, Prenatal Chiropractic and Pediatric Chiropractic. Our Wash Park Doctors are expert certified and trained in Sports, Pediatrics and Prenatal Care including massage, acupuncture, Webster Technique, Graston Technique, Laser, K-Laser, Kinesiology Tape, RockTape and Normatec.
Lisa Goodman, DC, CCSP, CACCP is a Certified Chiropractic Sports Physician (CCSP) and Certified Prenatal and Pediatric Chiropractor (CACCP). She is a CrossFit L1 and CrossFit Kids Certified Trainer. Dr. Goodman founded Washington Park Chiropractic in 2006 in Denver, Colorado. Dr. Goodman incorporates sports chiropractic techniques with prenatal and pediatric patients, she teaches mobility and taping classes locally, and is a contributor to POPSUGAR, Urban Life Wash Park and DC Aligned. She is a committee member on the boards of the ACA Pediatrics Council and the ACA Sports Council. Areas of special interest include prenatal care, ankle and wrist injuries, instrument assisted soft tissue techniques, strength training, and pediatric fitness. Stay connected with Dr. Goodman on Instagram @washparkchiro or @lisakgoodman