The Shocking Truth

“Ice and complete rest may delay healing instead of helping.”
 Gabe Mirkin, M.D., Creator of R.I.C.E. (rest, ice, compression, elevation)

you have to watch this…

The Shocking Truth

“Ice and complete rest may delay healing instead of helping.”
 Gabe Mirkin, M.D., Creator of R.I.C.E. (rest, ice, compression, elevation)

you have to watch this…

The Shocking Truth

“Ice and complete rest may delay healing instead of helping.”
 Gabe Mirkin, M.D., Creator of R.I.C.E. (rest, ice, compression, elevation)

you have to watch this…

The 3 Stages Of Truth

One of my favorite all-time quotes is by the famous German philosopher, Arthur Schopenhauer. “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

I know this report may be shocking, but you don’t have to take my word for it… I made sure that everything in this report is backed up by peer reviewed studies in respected scientific and medical journals.

So, before we get to what you should do, let’s start with one HUGE myth-buster about ICE… Now, I know what you’re thinking… ice??? Everyone is always telling me to ice a sprained ankle. It’s good for you, right?

Ice (whether you use an ice pack, cold therapy, ice baths, etc) is mildly effective as a short term pain reliever (it makes the area go numb and stops the communication between nerves and muscle). BUT, recent research strongly suggests that the negative side effects of ice are very damaging to the ankle.

Most people think that ice is a great for a sprained ankle, even acute and more serious ankle sprains. While acute soft tissue injuries in the ankle or relatively common (especially sports injuries), recent studies show that ice does NOT heal a sprained ankle and shockingly, can actually cause significant long term damage.

But, like I said, don’t believe me. Let’s get into the research…

Ice Gets The Cold Shoulder

“Traditional cold therapy (e.g., topically icing the injured area) may not be helpful… ice application has proved to delay the start of the healing and lengthen the recovery process… A prolonged period of cold on the skin was reported to lead to a reduction of the blood flow, resulting in tissue death or even permanent nerve damage.”

Ice says STOP to the immune system

When you get injured, the immune system sends in waves of powerful immune cells called Macrophages, to help you heal. Ice stops this critical process…

“A recent study using a mouse model of eccentric contraction has revealed that icing injured muscles delays muscle regeneration. The cause of this phenomenon is that icing delays the arrival of pro-inflammatory macrophages, which are responsible for the phagocytosis, or removal, of damaged tissue. Furthermore, this makes difficult for the macrophages to sufficiently infiltrate the damaged muscle cells.”

Please, keep in mind that if you have a severe injury or require medical attention, then ice may be warranted for medical reasons. In this report, we are focusing on more commonplace injuries that do not require medical attention.

“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.

“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 is NOT effective for healing a sprained ankle

National Athletics Trainers AssociationWhether you have a new or old sprained ankle, the National Athletics Trainers Association found that ice was an over-simplified method and NOT effective at speeding the healing of 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.

Ice can cause PERMANENT nerve damage

Journal Of Athletic Training

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.

Ice DISRUPTS the natural healing process


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

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.

Journal Of PhisiologyPowerful 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. 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.

Ever wonder why athletic trainers and therapists ice a limb for ONLY 20 minutes at the most?

The American Journal Of Sports Medicine

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.”

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.

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

Ice can be HARMFUL to athletic performance

Europian Journal Of Applied Physiology

A 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.

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.”

Here’s What Does Work!
(hint: HEAT)

Let’s take a look at the first technique we use in HEM Ankle Rehab to improve the speed and quality of the healing process.

Yes, it’s heat. Utilizing heat is just one small part of our healing system and we use a very specific technique that has been shown to supercharge the strongest and fastest healing results. But for now, you can start applying heat in a very general sense and still see some benefits right away.


To start, there are many studies that show heat therapy provides greater benefits than cold therapy in general, but let’s get more specific on why…

Heat is a great short term-pain reliever, but with NONE of the downsides of ice! The application of heat activates temperature-sensitive nerve endings (thermoreceptors), which, in turn, initiate signals that block the processing of pain signals.

In one study, they found that heat therapy “Pain relief was significantly greater with heat therapy than with acetaminophen or ibuprofen.”

And unlike all the down-sides of ice, heat has a whole lot of up-side!!

For example, heat has been shown to improve strength and flexibility, while reducing muscle stiffness and disability.

Instead of blocking the communication between nerves and muscle (ice), heat works by improving blood flow. This allows you to improve lymphatic drainage, which helps remove the debris and waste from the injury (instead of stopping or reversing it, with ice).

You won’t have to worry about nerve damage and diminished sports performance, like you do from ice. Instead, heat actually improves athletic performance!

Heat also improves the flow of powerful immune cells (i.e. Macrophages) that regenerate and repair muscle and tissue (instead of stopping it – sorry ice). This is a critical step in the healing process!

Taken altogether, that’s why studies keep finding heat works so much better than ice. For example, in one recent study, they examined the consequence of heat therapy on muscle recovery after skeletal muscle injury and found that muscle tissue started regenerating after 3 days with heat and after 7 days without heat.

They concluded, “starting of heat treatment immediately after muscle injury promoted the regeneration of muscle fibers”.


As you can see, we are NOT fans of icing an injury UNLESS it is directed by a medical professional, because of a medical condition or very severe injury.

If at all possible, we strongly suggest skipping the ice… Instead, you should be focusing on rehabilitation (healing) strategies (like heat) that improve the speed and quality of the body’s natural response to an injury. Here’s the good news… it’s easy and cheap!!

Over the last 15 years, we have field tested the best rehabilitation techniques and seen first hand the HUGE difference it makes in the healing process. Not only do people heal faster, but they also get back to pre-injury strength, stability and healthy range of motion.

So, please stop icing your injury. Instead, start applying some heat and if possible, start a really good rehabilitation to rebuild healthy and strong ankles… :)

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