• Should I Ice My Injury?

    blue ice pack on ankle

    I’m often asked about icing injuries when inflammation is present. The question is never “should I”, but how often and for how long. In order to answer those questions, and to really understand the answer, you need to know a little about the inflammatory and healing processes. I promise to keep it super simple. And short(ish).

    First, inflammation is not the enemy. It’s actually a natural and necessary process that happens whenever we have an injury, illness, or infection. Second, it triggers all sorts of other processes that not only aid in, but actually are responsible for, the healing process. That healing process starts with acute inflammation.

    Acute Inflammation

    Here’s what happens when you injure yourself or get an infection:

    • Blood vessels dilate to bring more blood to the area. That blood brings special enzymes and cells that clean up the injured/damaged tissue (or kill off invading organisms like bacteria and viruses) and eventually create new healthy tissue if needed.
    • Blood vessel and cell membranes become more permeable so all those enzymes, proteins, and cells can get out of the blood vessels and into the tissue to do their thing.
    • The injured area becomes swollen as a result of all the extra fluid that was carried in via the dilated blood vessels that’s now in the tissue via the permeable membranes.
    • The swelling protects the area from further damage by making it difficult for you to move the injured area or for invading organisms to move through the tissue to infect new areas.

    You know an area has acute inflammation if it has:

    • Warmth
    • Redness
    • Swelling
    • Pain

    Once the inflammatory process is well under way, the repair phase can start.

    Repair

    The repair phase is when the damaged tissue (or infection) is destroyed and removed from the area by macrophages and new tissue is formed by fibroblasts. Interestingly, the fibroblasts are anti-inflammatory. That means as your tissue is repaired, the inflammatory process comes under control and starts to resolve. This can start as early as 3 days after an injury.

    The shiny, new, repaired tissue is different than the original tissue. That means that once your injury is repaired, the body has to adapt to this new tissue and possibly regain strength if the injury was serious enough. That leads the body into the adaptation phase.

    Adaptation

    Once the area is repaired and new tissue has been laid down, the area needs to be cleaned up. So, the immune system switches gears and instead of damaged tissue being broken down and removed, the first responder cells get broken down and removed.

    But cleanup is only one part of adaptation. The second part is the continued build up and strengthening of the new tissue.

    Finally, there’s the actual adaptation or normalization. This is when the body gets used to the new sensations and movement possibilities. Remember, the repaired tissue (i.e. scar) is not only different to the original tissue, but the area has just gone through a wide range of sensations and lack of movement possibilities.

    Your body goes through most of this through this process when you actually use the recovering area. The mechanical forces generated by using it help to strengthen the area and adapt the body, but the neurological input that results from use helps the brain adapt to the new normal. The more it’s used, the greater the eventual possibilities. Rest is only beneficial during the acute inflammation phase.

    To Ice or Not to Ice Your Injury

    The old wisdom was to Rest, Ice, Compress, and Elevate (RICE) an injury but not anymore. Now we know that inflammation isn’t pathological, but actually helpful. The new wisdom is to only ice as needed to reduce pain to a tolerable level.

    Tl;dr

    Inflammation is good. Without it the body can’t heal or protect itself. It’s normally self-limiting and self- regulating. Because of that, we don’t want to interfere with the process more than absolutely necessary. So… don’t ice unless the pain is so bad you can’t stand it.