R.I.C.E. — it’s the standard treatment we’ve heard since childhood, right? But would you be surprised to hear that the man behind that method is now saying he believes it to be completely wrong if you’re using ice to recover from a workout or many injuries?!!!
For years, I’ve always assumed that when injured ice was the go to. However after putting ice on my knee repeatedly last summer I was told “STOP THAT”. In that particular case my muscles were tight and each time I iced them, I made them tighter.
In my case, once I started to apply heat the muscle relaxed and I could start doing assisted stretching, which is part of what helped to quickly resolve what I had been battling for months. This made me wonder when I should actually be using ice vs heat and what else I might not know about managing injuries.
Ice Vs Heat for Injuries?
After lots of research and talking to different PT’s, I found that the science is changing on the old RICE beliefs as more doctors are looking to ideas of active stretching and using heat…mostly I say find what works for you, but you should understand why more people are now saying to stay away from ice.
Here are some guidelines based on my discussions:
Ice is for acute injuries (pain management)
An acute injury is one that comes on suddenly, such as a twisted ankle, a pulled tendon and is usually accompanied by pain in a specific location often with swelling or “heat” in the area.
Ice can assist in both numbing some of the initial pain effects and reducing swelling by constricting the blood vessels, it does not speed healing it is just a short term action to stop pain and inflammation.
- Impact is greatest when used immediately after injury
- A fresh injury – 24 to 72 hours
- Swelling, redness, pulled muscle
- Never prior to a run since it causes muscle tightness
- Never more than 20 minutes at a time
- Best practice is to ice for 10 minutes, remove for 10 and ice again
- But the only real benefit is numbing pain, it is NOT promoting recovery
This is one of the few cases where even the mental benefits you might get from believing that it’s promoting recovery, might be undone by what is actually happening in the body.
Heat is for chronic injuries
Chronic injuries are those that have been going on longer than a week and tend to consist of things like tight muscles (IT Band Syndrome, runner’s knee, lower back pain), arthritis, aches, or muscle spasms.
It’s usually something that has been lingering or going on for awhile and is actually made worse by the application of ice. This is my favorite heating pad for runners knee and they make others specific to other body parts)
- Lingering injuries
- Relaxing tight muscles for additional stretching
- Increasing blood flow to an area (which helps with healing and good before activity)
- No more than 20 minutes is needed
- Can mentally provide relief as it feels more soothing and comforting
The next question though is how does cold therapy work in the world of recovery? Are things different than when we’re looking at an injury?
Ice Bath vs Epsom Salt Bath for Recovery?
When it comes to post run recovery, you might actually be doing more to delay your progress as a runner than to speed it up. That’s right this a recovery method that you should probably stop using ASAP!!
“The fact that icing feels so excruciating almost surely adds to whatever effectiveness the technique might have. Scientist call this an active placebo effect – our natural inclination to believe that if a treatment is painful, it must be very effective.” – a well stated thought from Christie Aschwanden in Good to Go.featured runner from The Local Elite.
Why stop doing ice baths?
Jumping in an ice bath will stop inflammation, but also postpone the healing process. What this means for you as a runner is this:
- inflammation from the run is how your body knows where it needs to get stronger
- inflammation is your body’s signal to send in everything it needs to repair
- by dampening that you are lowering the body’s response to rebuild
- by dampening it you are also slowing down the recovery process
- once the icing stops then the body is going to have to restart the recovery process
- studies have shown cold treatments reduce gains is muscle mass and strength
- it does reduce pain by causing numbness and reducing blood flow to extremities (hence the mental feeling that you’ve done something good)
I’ve been reading so much more about this and truly we’ve all had this particular piece of advice wrong for so very long. We’re so afraid of inflammation that we’re actually trying to tamp down the good stuff that provides growth.
Does that mean that my long beloved warm Epsom Salt Bath or hot tub might be a better solution??? Perhaps because my muscles get a massive dose of magnesium known to aid recovery and I mentally get a moment for my cortisol to drop, which is going to help me recover.
In fact, as it turns out the biggest benefit to nearly all recovery methods is forcing you to pause, slow down, and mentally relax. For me that means my bath is a win.
Are you icing injuries when you shouldn’t be? Ice or Heat learn what to use! Click To Tweet
Is there anytime an ice bath is good??
If you’re a major league baseball player, football player or track athlete who needs to compete again within say 24-48 hours then an ice bath could be worth your time. At that point you are postponing the recovery process of your body, so that you can try to delay soreness and continue to compete at that high level.
But during your marathon training, you gotta stop doing it after long runs and races!
Does Cryotherapy Work for Recovery?
Wait if all of this is true, then why the sudden huge spike in Cryotherapy?? And can Cryotherapy actually provide all of the benefits that it claims: weight loss, energy, faster recovery from injuries??
Because I’m never one to give you half an answer, I did my research and I agreed to go use a Cryotherapy chamber for 30 days straight during some of my highest mileage training in years.
I can say with 100% certainty it’s more enjoyable than an ice bath, but studies are actually showing that one of the few benefits of an ice bath might be the compressive effect of the water.
What about the reported mood boost?
A 2007 study did show that cold showers could help with depression through an increase in dopamine. Unfortunately, that mood boost declines as your body starts to realize that it can survive this crazy temperature drop!
What about the reported calorie burn??
While things like Coolsculpting are able to show some results, cryotherapy is NOT burning 800 calories per session. Shivering in a true hypothermic state burns 100 calories in 15 minutes and you’re no where near reaching this state, plus you aren’t cooling the brown fat which is around your collarbone.
Soo…cyrotherapy is not good for recovery?
“Anything that reduces your immune response will also delay muscle healing,” Physician Gabe Mirkin says. “The message is that the cytokines of inflammation are blocked by icing — that’s been shown in several studies.”
The one potential area where I could see it being useful is arthritis. In that state, you have constant inflammation and if this provides some relief then I say go for it.
What about Contrast Therapy?
Tim Ferriss and Ben Greenfield, two of my go to running podcasts, have talked about this numerous times, which of course lead me to do some additional research.
Contrast Therapy is going back and forth from cold to warm in the same treatment session. You can often find warm and cold pools at treatment centers (like the one I profiled here) or you can set it up to do at home using buckets or a tub.
Why does it work?
Again, I’m not positive this is a standard recovery treatment to jump on, but potentially one to consider for injuries.
One example, is when swelling limits range of motion, contrast therapy along with active range of motion appears to reduce swelling. The sharp sensory contrast between heat and cold appears to reduce pain. Both of which are going to help us progress back to physical therapy or simply get moving, rather than being stuck on the couch!
Or maybe just the heat alone based on my own experience loosening the muscles, allowing me to relax and my body to then put it’s energy towards recovery.
How to do it?
I think Jahn Tang does a fabulous job describing how to best use it, so I’m not going to describe it as well.
Read more on handling our running aches:
- Dealing with the most common running injuries
- Running pain vs. discomfort
- CBD Oil to promote recovery
- Is your pain all in your head?
- How to mentally recover from an injury?
- Why runners need to avoid pain meds?
Do you always reach for ice?
What’s your method for attempting to keep it on?
Other ways to connect with Amanda
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You hit the ball out of the park with this post! I’ve never heard of contrast therapy, so I’ll have to do some research on this. I treat a lot of young athletes in my clinic and I like to be on top of what’s the most effective. One thing I tell my patients who need heat is to fill a tube sock with rice, not too full, just enough so it can mold to the area that you want to treat and warm it in the microwave. Works great for areas like the neck that are hard to use the heating pad on.
Oh what a fabulous tip!! We have one of those packs you heat in the microwave and definitely gets used on the shoulders.
Jennifer @ Fit Nana
I’ve done an ice bath once. That was enough. haha
I generally only reach for ice if I’m actually hurt. If I feel tight or sore, I tend to just try to stretch it out. Sometimes, I’ll grab my heating pad – if I remember that I actually own one.
That whole contrast therapy sounds interesting!
I never knew when to chose heat over ice, but after reading this, I guess I have been doing it right. So now I know. Thanks for sharing!
Rach @ Girl On The Run
I totally agree with you re: pain meds! I very rarely take them for muscle issues, and if I do, it’s because the pain is so bad (i.e. like when I had tripped when I was running and gave myself a grade 2 sprain) and I am not running anytime soon.
I tend to only ice injuries, but that is interesting info about heat for chronic issues!
My sports dr and I had a talk about exactly this a few months back. It seems the word had always been ice, but now heat is coming into play more and more. I was an ice bath girl but now I’m embracing the magnesium soak too. I’ve been known to hold ice packs in place with a good old Ace bandage. Love me some Ben Greenfield podcast!
It’s really interesting to see the shift, but it’s hard to change what we’ve known for so long!
I tend to opt for ice, but heat does feel more relaxing, I had not heard of contrast therapy…makes total sense, though because it’s the best of both!
Great post! I never knew about when to use heat on injuries!! Thanks for sharing!
I recently wrote a post about this topic too. As a physical therapist myself, ice is usually safer to start with but then you have to go with personal preference! Everyone’s body is different and we all have unique needs. I personally reach for ice and love ice baths because they make me feel so much better. However, I know many people who can’t stand ice and that’s ok!
This was a very informative post, Amanda. It’s been so long now since I’ve got an injury from training I haven’t even considered the ice Vs heat method of treatment – I just always used to go for the ice pack without even giving it a second thought. I’m glad I came by this post now. It gave me something to think about.
Thanks for sharing the science and reasoning behind each recovery method. As a previous ice bath lover, I was amazed to hear how little it actually helped me. I’ve been doing contrast therapy for a few months (5min cold, 5 min hot, 3x) and I love it, and actually do notice a difference! Every little bit helps!
I definitely think there’s going to be more studies around contrast therapy coming!