Melting Bad Medical Advice: Ice

There has been lots of buzz on the internet in the last 18 months regarding, arguably, the most commonly and broadly dispensed armchair medical advice in the last 37 years: Rest, Ice, Compression, Elevation is slowly becoming defunct. This was all kicked off when Dr. Gabe Mirkin, the originator of the term “R.I.C.E” in 1978, retracted his stance on ice, specifically. Ice has never been used in Chinese medicine in almost 5000 years of recorded history. The relatively recent invention of artificial refrigeration notwithstanding, there are very specific reasons why ice is bad for you and why TCM warns against it.

My goal here is to make this as easy as possible for you to understand without going into specifics about research or exceptions (which will happen in later posts). There are three necessary and consecutive steps to healing as defined by modern medicine: inflammation, remodeling, repair. We also have this great feedback system built into our bodies to prevent us from causing more damage to an already compromised structure: pain.

Tackling pain first will be the easiest. Simply put, ice decreases speed and intensity of or potentially can stop nerve impulses. Pain is your body’s way of telling you that something is wrong. This is also the primary reason why cortisone injections are dangerously counterproductive: if you don’t know where the limits are and push through them you can very easily cause more tissue damage. At the very least you will be undoing the body’s efforts at healing. We will elucidate some alternative strategies for alleviating resting or unprovoked pain in future posts. The takeaway here is that by icing something that is painful you are destroying your body’s ability to tell you what is ultimately causing more damage.

For the more important concept here let’s start by clearing up a pervasive misconception - acute inflammation = good, swelling = bad, chronic inflammation = big red flag for your health. We’re concerned with the first two. Inflammation is the first step in the healing process where the body’s chemical markers for healing congregate in an area so that the healing can begin. Think of this as the fresh drywall, 2x4’s, nails, paint, and flooring that makes its way into a house undergoing a remodel or, perhaps, being repaired after being damaged by a tornado, fire, or flood. All of the old, damaged pieces of house have to come out, as well as the scraps of new materials that are being integrated. This is swelling, or at least potential swelling. Garbage. Anyone who has ever worked in construction knows that the key to a well run remodel/repair is cleanliness. If the garbage piles up, you now have swelling. The remodel is not the problem - the garbage you’re not dealing with is the problem.

To make it as binary as possible, raw materials are brought in via the blood while garbage is removed via the lymphatic system. Ice decreases fluid flow into (blood) and out of (lymph) any given area to which it is applied. This is physics, not medicine, and is explained by the Arrhenius Model. It is indisputable as well as observable in nature as anecdotal proof. Blood also causes the constriction of superficial blood vessels to help protect larger, more important structures (like the internal organs and locomotive muscles). This is also a fact that is observable in colder climates where fingers and toes go numb in sub-zero temperatures. To go back to our construction example, imagine your suppliers suddenly stop delivering the materials you need to fix your house. This is what happens when ice is applied to an injury. Without the proper materials, the homeowner or the body simply does with what it has and generally does a pretty shoddy job at that. The remodel takes longer than it should, the finished quality is not very good, and the long term durability of the repair is questionable at best. When you ice an injury, you’re causing the body to metaphorically paint over mold, splice wires with electrical tape, reuse corroded natural gas fittings, and patch rather than replace sewer lines. You’re creating chronic issues in your body, and you’re probably not going to pass that home inspection - hopefully you don’t end up with any fires or floods.

When you injure yourself it is painful. It is unfortunate. And it has consequences. No, when you roll your ankle you’re not going to be walking normal for a little while and yes, it is going to hurt for a bit. There are ways to mitigate pain and increase the speed of healing. For example, acupuncture and light movement will both increase blood flow and lymphatic drainage, and can even dull pain signals (reread the above paragraphs and ask yourself if you should be taking NSAIDs after an injury). But the important thing to remember is that you will have to give your body some time to deal with the injury. You don’t want your electrician cutting any corners, so why would you find that acceptable in your body’s work?