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DO NOT ICE A SPRAINED ANKLE

“It now appears that both ice and complete rest may delay healing, instead of helping.” 1
Gabe Mirkin, MD, Creator of R.I.C.E. (Rest, Ice, Compression, Elevation)

DO NOT ICE A SPRAINED ANKLE

“It now appears that both ice and complete rest may delay healing, instead of helping.”
Gabe Mirkin, MD, Creator of R.I.C.E. (Rest, Ice, Compression, Elevation)

Ice Sprained Ankle

“Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”
– Dr. Nick DiNubile, Editor in Chief, The Physician And Sports Medicine Journal

Ice Sprained Ankle

“Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”
Dr. Nick DiNubile, Editor in Chief, Physician & Sports Medicine Journal

Many people think that a sprained ankle is a minor injury that can heal itself with a little bit of time, ice and rest. But, we are now learning that this does NOT heal a sprained ankle and can actually cause significant long term damage…

Several new studies in people and animals suggest that a single sprained ankle can alter how well and often you move for LIFE. In one study, students with chronic ankle instability moved significantly less than the other students, taking about 2,000 fewer steps on average each day.
Don’t Just Walk Off a Sprain,  Gretchen Reynolds, The New York Times, September 9, 2015

Several new studies in people and animals suggest that a single sprained ankle can alter how well and often you move for LIFE. In one study, students with chronic ankle instability moved significantly less than the other students, taking about 2,000 fewer steps on average each day.
Gretchen Reynolds, The New York Times, 09/15

While ice is mildly effective as a short term pain reliever (it makes the area go numb and stops the communication between nerves and muscle), recent research strongly suggests that the negative side effects of ice are very damaging to the injured area. Below, you will find the research to back this up…

Instead of ice, recent studies strongly suggest that you should properly and fully heal a sprained ankle with rehab (that is why we created H.E.M. Ankle Rehab, so you could fully and quickly rehab your ankle at home). High quality ankle rehab has been shown to significantly improve the speed and quality of the healing process as well as reducing the risk of future injury without ankle braces, wraps or tape.

ICE IS NOT EFFECTIVE FOR HEALING AN ANKLE SPRAIN

certThe National Athletics Trainers Association found that ice was an over-simplified method and NOT effective at speeding up the healing process for a sprained ankle.

“The inflammation process assists in healing. We don’t want to interrupt that”, says Tom Kaminski, the lead on the study.

Therefore, the study also suggests you SKIP compression too, which had no real impact on recovery.

Finally, the study found that exercise helped to maintain blood flow and flexibility to the injured ankle, both of which are proven to speed up recovery. 2

ICE CAN CAUSE PERMANENT NERVE DAMAGE

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Researchers found that when muscle tissues cool from icing the skin, blood vessels constrict and shut off the blood flow that brings in healing cells.

After the ice is removed, the blood may then return, but the blood vessels may not open for many hours after the ice application.

This research team found that this can cause the tissue to die due to lack of blood flow. It can also lead to temporary or permanent nerve damage and disability in the individual or athlete.

Therefore, ice application does not boost recovery after exercise and can instead cause tissue and nerve damage. 3

ICE DISRUPTS THE NATURAL HEALING PROCESS

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It is essential to understand that inflammation is NOT bad. It is a critical part of the healing process.

Tissue that is damaged through trauma or vigorous exercise requires inflammation. When muscles and other tissues are damaged, your body sends inflammatory cells to the damaged tissue to promote healing.

Inflammatory cells rush to the injured tissue to start the healing process4

Powerful immune cells called macrophages release a hormone called insulin-like growth factor (IGF-1) into the damaged tissues after an injury.

IGF-1 is essential for helping damaged muscles and ligaments heal. Gabe Mirkin, MD states, “Applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.

Healthy, fast healing is significantly aided by INCREASED blood flow. Obviously then, decreased blood flow means slower healing times and increases the chance of re-injury or the development of chronic pain.

Did you ever wonder why almost all athletic trainers and therapists ice a limb for ONLY 20 minutes?

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In 1980, at the American Orthopedic Society meeting for Sports Medicine in Big Sky, Montana, and then again in 1981, physicians from the Louisiana State University School of Medicine reported on five athletes who obtained nerve palsies (nerve injuries usually to the peroneal nerve that moves the foot up) from too much ice around the knee.

The conclusion of the article was, “Applying ice for more than 30 minutes, and preferably for not more than 20 minutes, should be strictly avoided.” 5

After you sprain your ankle, this immune response can last for up to 1 week… Since, ice reduces the levels of IGF-1, we would expect to see muscle regeneration slow down.

Therefore, it is no surprise that a recent study concluded that ice appears to delay the return to normal of muscle damage markers. 6

Put together, these results indicate that using ice on an injury disrupts the body’s normal and healthy response. 7

ICE CAN BE HARMFUL TO ATHLETIC PERFORMANCE

00421A study done 2009 looked into the effect of cold-pack application on hormones on young elite handball players.

Various anabolic hormones, catabolic hormones and anti-inflammatory cytokines were reviewed.

The twelve male players performed 4 × 250 meter treadmill run, at 80% of each individual’s maximal speed, followed by a rest period with and without local cold-pack application.

Pre, immediately post, and 60-min post-exercise blood samples were drawn.

The results? Local ice therapy immediately following sprint-interval training was associated with greater decreases in both pro- and anti-inflammatory cytokines and anabolic hormones supporting some clinical evidence for possible negative effects on athletic performance. [REF]Nemet D, Meckel Y, Bar-Sela S, Zaldivar F, Cooper D, Eliakim A. Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial. European Journal of Applied Physiology. November 2009, Volume 107, Issue 4, pp 411-417.[/REF]

Another study Mirkin cited was in Sports Med, Nov 28, 2011 which stated, “Ice is often used as short-term treatment to help injured athletes get back into a game.

The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination.”

Mirkin goes on…”In this review, a search of the medical literature found 35 studies on the effects of cooling.

Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running.

Notes:

  1. Mirkin G. Why Ice Delays Recovery. March 16, 2014. http://drmirkin.com/fitness/why-ice-delays-recovery.html. Accessed June 4, 2014.
  2. Journal of Athletic Training 2013;48(4):528–545, doi: 10.4085/1062-6050-48.4.02
  3. Malone T, Engelhardt D, Kirkpatrick J, Bassett F. Nerve injury in athletes caused by cryotherapy. J Athl Train. 1992; 27(3): 235–237.
  4. Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai C, Harris MB, Kuo CH. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res. 2013;27(5):1354-61. doi: 10.1519/JSC.0b013e318267a22c.
  5. Drez D, Faust DC, Evans JP. Cryotherapy and nerve palsy. American Journal of Sports Medicine. 1981; 9:256-257.
  6. Tidball JG, Wehling-Henricks M. Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo. J Physiol. 2007; 578: 327-336.
  7. Tidball JG. Inflammatory processes in muscle injury and repair. Am J Physiol Regul Integr Comp Physiol. 2005;288:345-353.