Ep. 7: MYTHBUSTING: why icing injuries is harmful, not helpful

People, please stop icing your injuries!! Today we are going to be busting the stubborn myth of icing. This is such an important one to raise awareness of, as it’s so entrenched in the mainstream medical field despite lack of any evidence of benefit and clear evidence of harm. So what do we do instead? Luckily Chinese Medicine has a tried and tested approach to healing, with thousands of years of clinic use. It's so effective that the latest biomedical guidelines for healing soft tissue injuries echo traditional wisdom. So join me to find out how to heal more completely and efficiently! Show Notes Transcript Today we're going to get into some health mythbusting, and we are going to be busting the stubborn myth of icing an injury. This is such an important one to raise awareness about, as it's so entrenched in the mainstream medical field - and it's often the first thing that many of us will think to do when we injure ourselves, or if we're recovering from certain surgeries. But despite it being so prevalent, unfortunately icing an injury not only lacks any evidence of benefit, but we are also seeing clear evidence of harm, in its delay and slowing of healing. Icing is directly contradicting our understanding of how the body heals, from both an Eastern and a Western perspective. It's really important to bust this myth apart, so let's get into it. When did the idea of icing become so common in the first place? Well, the widespread idea of icing an injury dates back to the 1970s ,and it was bedded down in the acronym (many of us who are a little older might remember) RICE, which was the standard first aid treatment for injuries. RICE stands for Rest, Ice, Compression, Elevation, and itwas established as best practice back in the seventies and eighties. The term RICE was coined by the sports doctor and fitness guru, Dr. Gabe Mirkin, and the idea of RICE as the first-line treatment was further spread in his bestselling title Sportsmedicine. Now since then, Dr. Mirkin has realised that icing an injury is actually harmful - not helpful - and I really admire his openmindedness and ability to admit that he was wrong. This is the scientific method and a spirit of inquiry in action, which unfortunately doesn't always inform the advice and practice guidelines out there. So it's really awesome to see Dr. Mirkin being openminded and continually updating his knowledge and approach. As Dr. Mirkin says "RICE is something that just stuck and it's wrong". Meanwhile, in many traditional medicines, for thousands of years the standard treatment for injury is the opposite of icing. We use varying treatments that will promote circulation and the growth of new tissue, and we do this with modalities such as acupuncture, cupping therapy (which had its moment in the limelight a couple of years ago with a lot of the Olympic athletes sporting the big dark spots on their backs, and it's also been seen gracing the red carpet!), heat therapy - whether in the form of infrared heat lamp (which feels amazing!) or moxa. Moxa is also known as moxibustion: this is an ancient practice that involves the burning of mugwort and certain other herbs which release volatile oils - these are burnt near the skin and provide a gentle, warm feeling. It feels amazing and it speeds up recovery of topical injuries, even things like insect bites, and certainly feels really lovely for arthritis and pain conditions as well. So with all of these modalities, we're looking at improving circulation and promoting new tissue growth. We also do that with both topical and internal herbal medicines that promote recovery. Some of these herbal liniments in particular have been fine-tuned by Kung Fu fighting Shaolin monks in China. These guys have had ample opportunities over the centuries to observe the effects of herbal medicine for a vast array of training injuries, so these liniments have been tried and tested over millennia. So where did we get the idea in the West that ice could be helpful in injuries? Well, first let's have a look at what happens when we do injure ourselves. When that happens, whether it's a cut, a sprain, a bruise, a fracture, a herniated disc and so on, the body mobilizes its innate healing defense system, which is characterized by inflammation. And I touched on this in some early episodes, but the process of inflammation is commonly characterized by four qualities that many of us (who have had perhaps a sprained ankle or a pulled muscle or cut ourselves) would be well familiar with. These are redness, heat, pain and swelling, and these qualities are uncomfortable and undesirable in some ways, but they're side effects of the healing work that the body is taking care of behind the scenes. They're an essential part of healing! The redness that we see is a result of the dilation (or the opening up) of the smaller blood vessels near the injury, and increased blood flow to the area: this allows the flushing out of debris, allows us to deal with any bacteria or immunological threats and allows for tissue healing. The heat that is characteristic of inflammation is similarly due to increased blood flow in the area, as well as arising from some chemicals that the body releases in order to start healing the injured space. The swelling arises from additional fluid that rushes to the area, and this fluid contains white blood cells (amongst other biochemicals that the body needs to heal and protect the injured area). Together with other chemicals released by the body's defense system, these fluids also contribute to the fourth quality, which is pain. So this understanding of why the side effects of pain, redness, heat, and swelling are occurring, helps us to see that even though it's uncomfortable and a nuisance and it slows us down, inflammation is a fundamental and necessary step to healing. Therefore any interventions that we can apply to support this process will speed healing and allow more complete recovery, while anything that we do to hinder this can delay, or even permanently affect, healing. Back in the seventies, when people realized that putting ice on an injury could cut down pain and swelling, icing was implemented to get injured athletes back on the field immediately after an injury. From there, the idea became more and more widespread. To the point where the idea of ice bathing or cold water bathing after training is now incorrectly and widely believed to be helpful. Pain and swelling are the body's way of immobilizing an area, so that we can't do any further damage to it, so therefore icing an injury will certainly stop the pain signal (allowing a sports person to get back out on the court, or allow them a few more minutes on the field), but by slowing that pain signal, it's going to take away the body's innate warning mechanism to prevent further loading and damage to the area. So it's absolutely going to slow down healing in the long run! And this understanding has been backed up by a whole spate of studies that I've listed in the show notes. These show that there were no objective benefits to cryotherapy or icing, and in fact that it delays healing. The only noted change was that people were able to use the effected area more intensely after 24 hours of icing, but again, this is just due to inhibiting that important protective (and essential) pain signal that protects us from overusing an injured area. The same study confirmed no measurable actual benefits, or long term benefits, in healing. So we need to ask ourselves: is short term pain reduction a parameter that we want to use when we consider the best approach to healing an injury? It is literally short term gain for long term pain! On a subconscious level, we understand that icing slows things down. It's even in our common expression of "putting something on ice", meaning to delay or postpone or shelve something indefinitely. And again, this is what we are literally doing to the healing and optimal function of the injured area. This extends also to the use of nonsteroidal antiinflammatory drugs (NSAIDs) like Voltaren and ibuprofen - whether they're used orally or topically as a gel. The name of the drug says it all: they are anti-inflammatories, so they deal with pain and swelling by shutting down inflammation - but at the cost of long term recovery. Likewise, cortisone, which is another popular intervention, both orally and injected into joints, similarly stops healing. There is ample evidence regarding how cortisone and other steroidal anti-inflammatories inhibit the production of healing tissue. In fact, tendon surgeon, Professor Hakan Alfredson described in a British Medical Journal (BMJ) podcast recently, how multiple cortisone shots into an area can lead to dead tissue, reduced healing and wound breakdown. Two other studies, published in Radiology and Skeletal Radiology, just last year discuss observing accelerated progression of osteoarthritis, complications with joint and bone destruction and death, bone loss, stress fratctues, and also collapse of the femoral head (which is the head of the hipbone). So all these interventions are providing potential short term pain reduction, but with a long term loss of function and degradation of the tissue. Chinese Medicine is the original functional medicine. It has always been focused on addressing the root cause of a presenting complaint. As we see it, healthy function stems from healthy flow and circulation, and the communication of all the body systems. As one of my teachers very memorably pointed out: the difference between a live body and a dead one is heat. It's the spark of life! And when we die, the first thing that stops is movement, so let's not shut down that vital movement - or "spark of life" - with cold. Let's preserve it and support it, with supportive therapies. Our bodies are sending out this message too; often when I mention to my patients the difference between heat and ice therapy,...