8th June 2015

Some people, such as Dr Gary Reinl (who is a PhD and rather experienced trainer in the United States) would say a resounding NO. Indeed, his book entitled ‘Iced’ aligns cooling an injury with archaic medical practices such as bloodletting (Victorian doctors thought the cure for almost any malady was to drain someone’s blood). Is a humble ice pack really that bad? Ice has been the cornerstone of acute soft tissue injury management for many years, and in spite of some anti-ice proponents, it is still commonplace to see injured athletes with various body parts wrapped in ice on the side-lines.

Like so many practices within sport medicine, ice developed through anecdote. The ancient Greeks, who were partial to the odd sports injury, worked out that an acute strain to a muscle or ligament soon heats up, swells up and get pretty sore – icing is therefore a nice example of Aristotelian logic. Fast forward a few thousand years and we know a lot more about injuries, inflammation and tissue healing, however high quality clinical trials showing the effectiveness of ice are conspicuous by their absence. We only have one research study into the effects of icing on muscle strain injuries!!

But should the criticisms from the anti-ice camp be so dogmatic, so passionate, or so vitriolic? This can happen a lot in the science ie. a lack of conclusive evidence fuels polarised opinions (am thinking barefoot running junkies or the sugar vs fat diet brigades). Surely science is meant to make things easier, give us clear conclusions based on deeply thought out hypothesis? However, science in sport is only useful if it is used responsibly. So here are some rules to help separate the wheat from chaff, I am using icing as an example, but these kind of hold true for a lot of areas of sports medicine:

1). Lack of evidence for something, does not necessarily mean that that something is not effective. Although it would be nice to base all life’s decisions on data, in many instances, the research has not yet been undertaken. There is actually clear evidence that ice is an effective analgesic. It might not impact on the severity of your injury, but you will feel a lot more comfortable.

2). Consider the empirical evidence, in conjunction with underpinning science, clinical reasoning and most of all common sense. The laws of physics support the use of ice post injury. Am thinking injury = chaos, entropy, heat death theory etc.

3). Is there evidence of harm? So many of our practices in sport are ahead of the curve; in other words, sometimes athletes don’t want to wait for the latest meta-analysis or randomised controlled trial, they just want to take a risk. I would say that’s fine, as long as there is a scientific rationale (see point 2 above) and there is no evidence of harm or likelihood of harm. Incidentally, plenty of people have been harmed using an ice pack but most have been due to user error eg. falling asleep with an ice pack on or venturing into a -120 degree cooling chamber wearing sweaty socks (Justin Gatlin) #frostbit!

4). Be careful what you read. Google ‘ice prevents healing’ and see how many hits come up. One hit links to an article published in a reputable broadsheet newspaper, which summarised the findings of a primary research study from the Federation of American Societies for Experimental Biology journal. If you take the time to go to the source, you would soon discern that a more suitable headline for this journal piece might be ‘Blocking important Growth Factor prevents muscle healing in mice’. So in reality this research has no relevance to sport as a). it was undertaken in mice, b). it was a gene altering study, and c).no ice packs were used. The problem with induction. Blocking inflammation stops healing (therefore) Ice blocks inflammation (therefore) Ice stops healing. Wrong.

5. Beware of social media(ocrity). Remember, Dr Google didn’t finish medical school. The power of social media can sometimes be a good thing (see Sepp Blatter), but it can also hasten the madness of crowds. Sadly a ‘like’ or a ‘retweet’ is often held in the same regard as an old fashioned peer review. The corollary is that many scientific ideas or poorly performed research studies are getting far more air time than they deserve. The message to ‘never ice your injury’ is certainly one of those.

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