It’s insane to me that we’re still having this conversation about ice and recovery but I think it’s still important to address the science so we can finally begin to put this to bed. Ice DOES NOT WORK as a recovery modality. Surprised? Does this go against the things you’ve been taught to be true when it comes to injuries and recovery? Ice makes the pain go away so it’s obviously helping right? Actually no. So, get ready to question your thought processes when recovery is concerned because we’re going to address all of it in this article.

How Ice Came to be a Recovery Modality

Believe it or not, there is literally zero science behind icing injuries or sore muscles being anything outside of an exercise in futility when it comes to recovery. None. However, there are peer reviewed articles showing evidence of the deleterious effects of ice when it comes to recovery. That being said ice does indeed help numb the pain by reducing nerve conduction velocity, which is just a fancy way of saying it slows down the pain impulses from the pain site to the brain. Because of this it’s been used by athletic trainers since the inception of the industry. It helped reduce pain, and it was cheap and abundant so no one ever really questioned it. You see, back in 1881 Harvard hired a guy by the name of James Robinson to help out with their football team’s conditioning and to provide rubdowns for players in an effort to speed recovery. He was the first ever athletic trainer. Shortly after that most colleges began employing people to provide these services because it seemed to work having these people there to provide recovery methods for their athletes. Better recovery means more work, and more work (when we can recover from it) is what wins championships. So an industry was born.

The problem with this new industry is that early on, like many new industries, it was ill funded. College football wasn’t the cash cow it is today, so athletic trainers were left with nonexistent budgets (much like today believe it or not) for supplies. With this lack of funds they found what appeared to be a miracle cure for pain caused by injuries and intense training: Ice. They even had machines that made it for “free”. This was an absolute win-win, but nobody ever bothered to look into how or why it worked.

Now fast forward to 1978 when a man by the name of Dr Gabe Mirkin decided he was going to set recovery methods back 100 years by coining the term RICE. RICE stands for:

• Rest

• Ice

• Compression

• Elevation

To break this down, he decided that the best thing for recovery is to lay down with the injury in an elevated position while compressing ice on the site of the injury/pain. If you utilized this method it was said to speed the recovery process, or at bare minimum not slow it down. The sad truth is that it was absolute bullsh*t and back in 2012 he came out and said that not only does it not work, it does the opposite of what it was billed to do. We’ll talk about how flawed this was as we breakdown what inflammation is and how we get rid of it.

Training and Inflammation

Training to get better whether it’s sprinting, jogging, walking, playing at high levels of sport, or lifting weights is merely the trigger for growth. This overreaching and performing tasks or volumes that we’re not accustomed to leads to physiological processes that force us to adapt, making doing those tasks again, easier. Training doesn’t actually make us bigger/faster/stronger, recovering from that training does. So if training is just step one, what comes next? Inflammation comes next!

Following (and during) training or intense play, the body floods the working/worked muscles with blood in an effort to drive oxygen and other nutrients where they’re needed most. You ever had a pump in the gym? Your muscles feel bigger because they actually are, they’re filled with more blood than usual. This blood is full of oxygen, glucose (sometimes) and inflammatory markers. Your body, even during training, is starting the inflammatory process in an effort to begin the recovery process. Your blood vessels are also dilated in an effort to drive as much blood to the area as possible, this is an important step in the healing/recovery process.

The Inflammatory Response

Following the trigger that is training/playing, the body goes through natural processes designed to help bring us back to homeostasis. The body is going to go through this process regardless of what we do and although we’ve been obsessed with finding ways to speed this process up, we’ve mostly just found ways to slow it down. You see, different tissues all have finite timetables when it comes to recovery and repair and we haven’t really been able to speed that process up. We’ve found ways to mitigate the pain associated with inflammation, but so far all of these things have slowed down the inflammation process. We simply cannot recover or repair the damaged tissue without going through the inflammatory process.

So what does this inflammatory process look like? It actually starts during the training process and will continue for a length of time depending on the amount of damage to the tissues. More damage typically means a longer inflammatory response which means more time spent in “recovery.”

During training the damaged muscle tissue releases attractants that begin and accelerate the inflammatory process. Mononucleated cells in the muscles are activated by this “injured” tissue providing a chemical signal to circulating inflammatory cells. Neutrophils will invade the site and release cytokines which attract and activate additional inflammatory cells. Microphages then invade the damaged tissue and remove debris from the darea through a process called phagocytosis. Lastly, a second round of microphage invasion occurs which eventually leads to muscle regeneration. This is the inflammatory process, which for all intents and purposes is actually the recovery process. If our goal is to be back on the field of play as soon as possible, why would we stop or slow down this process?

Vasodilation: Groceries in, Garbage Out

In my opinion, the single most important process to recovery is the vasodilation that occurs during and after training. This vasodilation (your veins and arteries expand) allows for two things:

1. More blood flow to the site of the damaged tissue

2. More blood flow out of the site of the damaged tissue

Think of your body like your house. You go grocery shopping every week so you can feed your family, and you take the refuse from those groceries out to the garbage cans and put them on the curb for takeaway. What would happen if we only allowed the groceries to come in, and you weren’t able to get the garbage out? Or vice versa if we only allowed the garbage to go out, but you couldn’t bring the groceries in? This entire process of your household would come to a screeching halt. You either wouldn’t be able to nourish your body, or you’d be living in filth and in both cases it’s going to take some time to get back on track once we open up both doorways. Your body works a lot in the same way, following damage to tissue you need to bring the nourishment (groceries) into the site, and you need to shuttle the byproducts (garbage) away from the site. How does ice effect this process?

Ice and the Recovery Process

So how does ice factor into this equation? Well, not very well to be completely honest. Ice is going to do a number of things to hamper the recovery process. The following are some of the problems caused by icing:

• It slows down local tissue metabolism

• It slows down nerve conduction velocity (good for pain, bad for movement)

• It constricts blood and lymphatic vessels

• It causes tightness in the tissue

• It promotes stagnation of blood in the effected area

We’ve gone over the inflammatory/recovery process, and now knowing the inflammatory response is one of blood flow and lymphatic movement, can you see how ice may present a problem? Constricted blood vessels, stagnation of blood, tightness of the tissue are all things that will halt this process. It’s going to numb the area but that’s relatively fleeting as well, that pain relief will be gone in 20 minutes tops. It just isn’t worth it.

How Do We Recover?

Well believe it or not, your body is a fascinating vessel. Turns out we’ve got all the necessary processes already built in, we come already assembled and ready to go. If we want to recover in the quickest way possible we need to MOVE. Remember how you’re supposed to bring the groceries in and take the garbage out? Well groceries in is pretty easy, you just let it happen and try not to do anything that’s going to stop that process (for example icing). Taking the garbage out is a little bit trickier, but it’s still pretty easy. The “garbage” gets carried out of the site of the damaged tissue via our lymphatic system. Our lymphatic system is very similar to our circulatory system with vessels woven throughout our body. The difference between our circulatory system and our lymphatic system is a big one though, our lymphatic system does not have a heart to move this fluid throughout the body. So how does this system function to move things throughout the body? Pressure changes.

These pressure changes are incredibly important. Have you ever had a really hard workout and then could barely get out of bed the next morning or even struggled when it came time to sit down on the toilet? Part of that is due to the damage to the tissue and there isn’t much we can do to change that. You’ve got tears in the protein structures of the muscle cells, and that’s going to cause some pain. But a good portion of that pain comes from all of those metabolic and hormonal byproducts from training/playing, they haven’t moved and they’re just hanging out in the muscle, because we haven’t moved! Usually after waking up we’re going to move around a little bit because our day is going to demand that we get up out of bed and get dressed ready to tackle the day. You ever notice that later in the day you start to feel a little bit less sore and you can move around a little bit more pain free? That movement throughout the day is caused by muscle contractions and those muscle contractions create pressure changes within the sore parts of the body which allow the lymphatic system to do it’s job. Movement is the key, and “resting” is a recipe for delayed recovery. If you want to speed up the recovery process, you’ve got to MOVE!

Active Recovery vs Passive Recovery Modalities

What is active recovery? Well, it’s exactly what it sounds like. We’re going to be active (move around) which is going to facilitate a timely recovery due to increased blood flow and lymphatic drainage. So why hasn’t this caught on with more physical therapists, strength and conditioning coaches, or personal trainers? Because they can’t sell it! There’s no money to be made in telling you to go for a walk, or go through an active dynamic warm up as part of a recovery routine. There is however money in creating products and services associated with recovery.

You ever heard of or been hooked up to a game ready? It’s essentially a cooling modality designed to create pressure changes within a joint. It continuously circulates new cold water around a joint so there’s a consistent heat exchange leading to quicker decreases in temperature. It’s basically like a “better” version of ice. We’ve already gone over why icing is a poor modality for recovery so I won’t dive into all of that, but try to understand that this modality is actually fighting itself. It’s slowing down recovery (via cold therapy) and simultaneously trying to speed up recovery by creating pressure changes via compression. While being hooked up to a game ready may make you feel special and like you’re “grinding” because your workout was so hard that you need to be hooked up to a cooling modality, it’s delaying the recovery process.

Next up is the Normatec. The Normatec is actually a pretty cool and useful device, it’s just been wildly bastardized by strength and conditioning professionals and physical therapists. The way a Normatec works is to create pressure changes (a good thing!) while you’re sitting around. These pressure changes help with lymphatic drainage and even blood flow, so they really can actually help facilitate recovery. The issue with these modalities is that they were created for people who can’t or struggle to move around. A person with a total knee, an athlete with a torn ACL, etc. It’s just a way to recreate pressure changes that you could create on your own via movement. They’re great for athletes traveling after a game when you’d usually be forced to sit on a plane or bus, the Normatec boots allow for pressure changes without movement. It can help kickstart the recovery process early and that’s a great thing! BUT, chances are you’re not jet setting on a team’s private jet for 6 hours following a game, you have the ability to go for a walk, or go through some form of active recovery. In addition to that, anything outside them being used directly after training isn’t really going to move the needle. While it’s cool to take pics for the Instas in your Normatec boots while hash tagging “recovery”, they’re not actually doing anything for you that you can’t do more effectively on your own. Bag the boots and go for a walk.

Ice baths are next on our list. Ice baths use, you guessed it, ice. An ice bath can get colder than just ice, so just like cryotherapy chambers it’s going to promote quicker heat exchange and penetrate deeper into the muscle. Ice baths are going to stop the inflammatory process (if they even penetrate deep enough to have the desired effect), but hey its for the gram!

Massage is next. I actually don’t have anything negative to say about massages. They can create a parasympathetic shift in the autonomic nervous system, leading to a rest and digest state promoting recovery. It can also help with blood flow and lymphatic drainage. If you’re wholeheartedly against getting up and moving around, a massage is your next best bet.

Movement is going to be the key to recovery whether it’s from an injury or intense training. Movement creates better blood flow, creates pressure changes needed for lymphatic drainage, AND can actually increase our work capacity depending on the type of active recovery we’re performing. If your options are passive recovery via cold modalities or going for a walk, save your money and go outside and walk!