To Ice or Not to Ice?

October 9, 2015 0 comments Pain and Injury

For many years Doctors, physiotherapists, osteopaths and others have told us to ice any soft tissue injury, such as a sprained ankle.   I’m often asked this question by my clients, should I ice my injury or not? Chinese Medicine says no, though as Western professionals suggest ice, this is hard for my clients to hear. However, cold is seen as slowing the blood flow and energy to the tissue so slowing down healing. Now it seems Western medicine is coming to this conclusion too, as it understands more about the role of inflammation in the healing process.


Ice delays healing

Since the 1970s, for any sports injury the RICE protocol was recommended, this stands for Rest, Ice, Compression and Elevation. Dr Mirkin who created these treatment guidelines is now critical of Ice and Rest, saying on his website this might delay the healing process. The article on his website ‘Why Ice delays recovery’ published in 2014 ( explains that ice causes blood vessels to constrict and reduce blood flow to damaged tissue and so the flow of immune cells which are not able to release growth promoting chemicals (immune cells called macrophages release insulin-like growth factor which initiates tissue regeneration). Once these blood vessels are closed down they may not open for many hours. Dr Mirkin says “This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.” Icing increases the chance of incomplete healing by decreasing inflammation and the blood flow to the injured muscles, ligaments and tendons. This increases the chance of re-injury or the development of chronic pain.


Chinese herbs enhance healing

We know that the blood supply to muscles is much higher than tendons and ligaments respectively and muscles heal quicker. It is of particular concern then that ice is often used for tendon and worse still when used for ligament injuries, where any decrease in an already restricted blood supply will have more severe consequences for healing. At a recent seminar I attended on sports injuries with Dr Zippelius (, a Chinese Medicine practitioner, icing was discussed. He explained how ice, by constricting blood flow and healing chemicals, also actually traps harmful chemicals such as pro-inflammatory cytokines in the damaged tissue. He explained how compression is better than either hot or cold application initially and analgesics if there is pain. In Chinese Medicine herbs (both topical and oral), ointments and pastes are used to speed up healing, together with acupuncture.


Anti-inflammatories delay healing

Dr Zippelius, agrees with Dr Mirkin, that essentially anything that reduces inflammation or the immune response will delay healing. So in addition to ice packs, this will include anti-inflammatories, such as Ibuprofen or naproxen, cortisone and immune suppressants. In Chinese Medicine terms these interventions are seen as weakening the body’s innate repair mechanisms (qi and yang). Indeed cortisone is seen as very cooling and causing stasis of qi and blood (reducing blood circulation). Dr Zippelius noted that steroid injections cause blood vessels to constrict which can lead to tissue dying. He cautioned that no more than 1 or 2 injections should be attempted, if at all, and bad technique can be very damaging to soft tissue.


Healing sports injuries with Chinese Medicine

We advocate topical liniments, sometimes internal herbs, compression if required, gentle movement and lots of acupuncture and Gua sha. Chinese Medicine works with the body’s own natural healing powers, rather than trying to suppress or hinder them.

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