Are coaches and physios giving the wrong advice about ICE?

Sustainable Rest

10 Dec

Ice may not be the best treatment for aching muscles — in fact, it could even be detrimental to recovery. The American Journal of Sports Medicine (2004), The Journal of Athletic Training (2004), The Cleveland Clinic (2011) … the consistent peer-reviewed results go on and on...

Recovery is the one thing that many of us struggle to get right. High performers often fail to realise their maximum potential due to injuries or illness caused by under-recovery. It's easy to be inpatient and push the boundaries in training and life because we believe “working harder” is the key to performance improvements… right? We must learn to let go of exhaustion as a status symbol and productivity as a measure of self-worth and start to cultivating play and rest.

Overview:

Cold therapy is often recommended by therapists and doctors to treat injuries, but these recommendations are based on old science.
If the goal of our current training block is to increase muscle mass, strength or explosive power we should probably skip the post-workout ice bath.
Ice and rest are no longer the best for muscle recovery.
The healing process required inflammation
Ice, or cold therapy, causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation
Taking NSAIDs (ibuprofen) have the same impacts as they slow down the inflammation and healing process.

Recovery has started to gain more attention over the last few years as high performers start to realises how recovery impact success. As with anything popular in the health and fitness space, products, services and marketing have quickly jumped onboard to take financial advantage of the recovery wave. Significant investments are being made into research to support cold therapy, saunas, compression garments, massage tools, supplements and so-called super foods.

R.I.C.E

In 1978, Gabe Mirkin published a sports medicine book that introduces the acronym R.I.C.E (Rest, Ice, Compress, and Elevate). Athletes and teams have used R.I.C.E guidelines for decades, but now it appears that both ice and complete rest may delay healing, instead of helping it. For many years we have been lead to believe that cold water immersion reduces inflammation in musculoskeletal tissues and regular cold water immersion enhances post-exercise recovery and resilience, thereby leading to greater adaptation to training.

The seemingly harmless act of icing has grown to become the most common injury response tool in the world, and, in the process, has done great harm to people everywhere. In ICED!, author Gary Reinl, reports the related facts so that everyone can bring themselves in from the cold. When you see the incontrovertible facts that icing not only does not prevent swelling but actually severely harms the healing process, you will never look at an ice pack the same again! [5]

A 2015 randomised controlled trial [3] took a group of physically active men and had them strength train twice a week for 3-months. Half of the group performed a cold immersion after each training sessions - sitting in a 10deg pool of water waster deep for 10minutes. The other half performed active recovery after each session - riding a stationary bike at low-intensity for 10minutes. Both groups gained lean muscle mass and strength, but the cold immersion groups gains were significantly smaller than the active recovery group and the Type-II (fast-twitch) muscle fibres only increased in the active recovery group. If the goal of our current training block is to increase muscle mass, strength or explosive power you should probably skip the post-workout ice bath.

A 2013 study in The American Journal of Sports Medicine, required athletes to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage. Gave Mirkin recently wrote an article "Why Ice Delays Recovery" [2] and now agrees that ice and rest are no longer the best for muscle recovery.

For years athletes have been jumping in ice baths post-training or completion to speed up recovery and prevent inflammation. When we exercise, we damage muscle tissue which causes muscle soreness, especially in the 48hr to follow (DOMS = Delayed Onset of Muscle Soreness). The body heals itself by using the immune system in the same way you use the immune system to recover form illness (you should NOT train when you are sick as this slows the body ability to recover from sickness). The healing process required inflammation. Your immune system uses inflammation to promote healing in the damaged cells. Inflamation causes the release of a hormone called Insulin-like Growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. Applying ice to reduce inflammation delays healing by preventing the body from releasing IGF-1.

Ice, or cold therapy, causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation [1]. The decreased in blood flow can cause the tissue to die and can even cause permanent nerve damage. Anything that reduces inflammation also delays the healing process. Taking NSAIDs (ibuprofen) have the same impacts as they slow down the inflammation process.

Cold therapy is often recommended by Physio therapists and doctors to treat injuries, but these recommendations are based on old science.

In contras, cold water immersion can provide benefits for other aspects of physical exercise recovery and adaptation. Cold water immersion at fourteen degrees celsius has been shown to reduce the degree of perceived muscle soreness and have an effect of decreasing sympathetic nervous system (fight or flight). Cold immersion at temperatures below seven degrees celsius has been shown to increase sympathetic nervous system activity.

By reducing body temperature post exercise, cold water immersion can decrease thermal demands and potentially increase heat storage capacity. These effects can result in less CNS fatigue, lower rates of perceived exertion and better recovery between closely scheduled workouts [4].

By reducing blood flow to the extremities, cold water immersion may increase central venous pressure and central blood volume which can result in less cardiovascular strain, increased delivery of oxygen to muscle and greater cardiac para-sympathetic activity. All of these responses may translate to greater recovery following endurance exercise.

Cold water immersion has been shown to increase gamma co-activator 1-alpha (PGC-1a), a master regulator of mitochondrial (the cell energy factories) biogenesis. Aerobic exercise combined with cold water immersion appears to induce mitochondrial count and could potentially improve aerobic endurance.

Ice bath could potentially be useful to speed up recovery in-between frequent training or competitions (same day events, back-to-back days)
Active recovery is currently accepted as the gold standard and is arguably the best way to recover after a hard session. Active recovery is low-intensity steady state cardio used to increase blood flow to the muscles, helping to lower inflammation and bring nutrients to the muscles.
Alternating cold water and warm water (contrast therapy) may help speed up recovery as the cold water will slow down circulation and the hot water can speed it up again. Increase blood flow to the muscles seems to be the best way to increase the rate of recovery.
Cold water baths (14deg+) are potentially a better solution than ice baths for recovery

Further research is warranted to understand the physiological effects of cold water immersion in greater detail, and to establish stronger evidence-based prescription guidelines in terms of the optimal temperature, duration, timing and frequency of cold water immersion to promote recovery and adaptation to exercise.