Do you go straight for the ice when you hurt yourself? Do you use ice baths to speed recovery from tough workouts? You’re certainly following authoritative advice in doing so — doctors and physios have been recommending this since 1978. That’s when Gabe Mirkin coined the acronym RICE, for “Rest, Ice, Compression, Elevation,” the four steps for treating injuries.
I have a story for you about that.
When I was a dancer in my 20s, I got very severe achilles tendonopathy (they called it tendonitis back then) in both feet. I couldn’t walk without pain, couldn’t even think of dancing, had a year of rehab that was worse than useless at a prominent physical therapy clinic for dancers, and at the end of that time was told I’d probably never dance again.
As the years pass, I’ve learned that the elements of that rehab are all now known to slow healing at best, if not cause further damage.
When I think of all the anti-inflammatories I took, month after month of ultrasound treatment (which breaks down connective tissue!), and all the pointless rest and counterproductive inactivity, I could just cry. At the time, I did.
Now I can add all those hours of icing each day to that list.
Gabe Mirkin recanted his recommendation to ice injuries a year and a half ago based on recent research. Whispers that icing might not be helpful as previously thought, and possibly even harmful, have been circulating in the sports community. However news spreads slowly, and odds are good you’ve still been icing the places that hurt. Let’s do something about that so you get better faster.
This past week Rebecca Dietzel, an anatomist and biochemist who has worked with my company in NYC, emailed me to tell me about the website she’s created with her colleague Jennifer Denys. They work together at Canada’s National Ballet School, and they made the website to share what research now shows about the effect of ice on injuries and recovery. They’ve also created an alternative approach to use instead of ice, which they call the BE CALM Protocol.
So why shouldn’t you ice? Because it turns out that icing constricts blood vessels, slowing and reducing the flow of blood to an injured area. This means that macrophages, whose job it is to clean up injured tissue, can’t get there as quickly or in large enough numbers as necessary. This slows your healing!
Furthermore, ice also slows the flow of lymph carrying debris away from the site of an injury –also not helpful.
The effects of icing last for hours afterwards, meaning hours of impaired healing. And many runners ice regularly, prolonging the effect.
As for ice baths after hard workouts, not only do they inhibit recovery for the same reasons ice interferes with healing, but they also reduce the ability of muscles to replenish glycogen stores, hampering your recovery.
Ice also “…results in losses of strength, flexibility, and the ability of our nerves to conduct signals to our muscles,” according to Dietzel and Denys.
The only reason to ice is that it provides pain relief. So if you have very intense pain, Dietzel and Denys offer a protocol of extremely restricted icing to help you cope.
What should you do instead of icing? For that I recommend you read about the BeCalm protocol from Dietzel and Denys’s website. They’re not charging for it or trying to promote themselves, they just want to get the word out, so everything you need to know is right there, concise and clear. Go read it now. Then tell your running buddies about it. Let’s really spread the word on this one.
7 thoughts on “Why Runners Shouldn’t Use Ice (and what to do instead)”
However, It seems to deal with the first couple of days.
My major concern is rehabilitating.
Last time I had an inflemated achiles tendon I did have a terrible time for a couple of days. with 2 borders to cross and a 12 hour flight (carrying baggae…). And then it just wouldn’t go away for weeks. my anckle was red, inflamated and painful, grounding me from any running activity of course.
do you have any insights for that phase?
That’s a good question, Alon. I’m going to forward this to Rebecca Dietzel and ask what she recommends. From a movement perspective you should do your best to help your extensors work — make sure your pelvis is moving, your glutes are working at the appropriate times, you’re not holding yourself in a flexed position. Anything that helps your back and glutes work better helps your achilles. However as far as the other elements of rehab I defer to Rebecca.
I have just discovered your blog. A big thank you as I have already found it so informative. I was a novice runner up until last year and really enjoying all the progress I had been making. In addition I walked a lot, cycled and was a mean Salsa dancer!
Then ‘bam’- I suffered a blow to my right ankle. Nine months, three doctors, two physiotherapists and a stint in a AirCast boot and I’m still in physical therapy. Peroneal Tendonopathy really is no joke! I noticed reading your story that you suffered Tendonopathy of your achilles. How can I learn more about the latest rehabilitative techniques in this area?
I’d really appreciate some pointers!!
Katrina (AKA Frustrated Salsa Aficionado)
I’m sorry to hear about your injury, Katrina! Look for my posts on plantar fasciitis, the resources for that will help with your situation as well. Best of luck!
Thank you for your post, Jay. I skimmed it shortly after you published it more than three years ago and remembered it after I crashed on my bike today when I hit a slightly raised barrier that prevented me from entering a left-turn lane. I have a nasty bruise on my left wrist and elbow and the muscles of my arm are painful. I will follow the BE CALM protocol. I don’t think I broke any bones but I might get some x-rays to be certain.
Sorry to hear about your accident, John! I hope you recover quickly. BTW it’s not a bad thing to wait a couple of days before going for x-rays, I’m told, because sometimes a fracture won’t show right away.
It’s been two weeks since my crash and I’m still bruised but able to do a little more every day. I plan to depart on my 4000-mile solo bike trip on May 28th, just seven weeks from tomorrow. I’m experiencing a lot of cognitive dissonance as I prepare for my trip while unable to ride as hard as needed for the trip. I hope that in two or three weeks I’ll have recovered from the crash so that I can start training for my trip.
That’s very interesting about waiting to get x-rays. I have an appointment this Thursday with Dr. Craig Capeci, the orthopedist I saw when my right knee blew up in 2012.
You can read about my crash here: https://johnlinkbikingadventures.blogspot.com/2019/04/planning-itinerary-update.html
Do you know Lynn Martin, my friend who teaches Carl Stough’s Breathing Coordination? I told her about the BE CALM protocol and she said that she and Rebecca Dietzel have been friends for decades.