Conventional wisdom favors icing after a hard workout to reduce inflammation and begin the recovery process. Many athletes, including pros, swear by the idea. But the science behind cryotherapy might be a little shaky, and some experts recommend warmth as a more natural way to begin healing overworked muscles.
I asked the opinions of two people who confront this issue every day. Robert Gillanders is a physical therapist in the District of Columbia and a spokesman for the American Physical Therapy Association. Steve Hays is the track and cross-country coach for Whitman High School in Bethesda, Md., and a 2:52:19 marathoner.
Q: Your athlete or client has just completed his hardest workout of the week. What is your advice about recovering quickly and effectively?
Gillanders: I generally recommend movement, compression and elevation. This could come through a structured cool-down after the workout that includes active stretching. It could come through wrapping a painful or swollen area with compression garments. It could come by elevating the involved areas.
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If I were forced to choose heat or cold, I would say warm. A warm tub, say body temperature, can provide an environment to get some hydrostatic pressure, an in-place stretch and active movement. It is not great for elevation, but you can get that later by putting legs or other heavily worked areas higher than your heart.
Recovery is key to preparing the body for the next workout. This includes restoring the calories expended and rehydrating, as well as ensuring adequate sleep before the next workout. A hard workout will create inflammation because it is the body’s way of starting the healing process for the micro-injured area. Jumping in an ice bath will stop inflammation but also postpone the healing process.
Hays: I normally tell my athletes to use both ice and heat — two cycles of 10 minutes of ice, alternated with two cycles of 10 minutes of heat. Ice slows blood flow and heat has the opposite effect, increasing blood flow. The increase in blood flow helps to flush out the byproducts created by the workout, and the ice helps to reduce inflammation.
During a hard workout, blood rushes to your muscles, carrying oxygen and the needed energy to complete the workout. After a hard workout, muscles are inflamed and you have countless micro-tears in your muscles. You want to flush out all the waste that is the byproduct of this process.
The cooling part of this process doesn’t need to be an ice bath; 65 to 75 degrees is fine. The cold water reduces the blood flow to the muscles and reduces the inflammation while still allowing for waste products to be flushed. Athletes experience less post-workout soreness after a cool bath.
Q: Have you tried other methods? What led you to the practice you recommend today?
Gillanders: In physical therapy, the use of ice has been long-standing. Post-injury, the standard has been RICE: rest, ice, compression and elevation. What caused me to change was that the relevant research really did not support RICE, especially rest and ice.
We know movement is good. No longer do we recommend bed rest for back pain, or staying in bed after surgery. In fact, we recommend the opposite. Whether it is post-whiplash or post-knee replacement, we know that appropriate movement is good. It brings nutrition to the joints, which maintains range of motion and health in the area.
Ice also is discouraged mainly because it stops the body’s natural path toward healing. The body has three stages of healing: (1) inflammation (2) repair and (3) remodel. Without inflammation, we do not proceed to the other stages of healing. So the use of ice to control inflammation makes no sense. Why stop the first stage of healing?
The same thing goes for taking nonsteroidal anti-inflammatory drugs such as ibuprofen. Because they block the inflammatory cycle, they can limit the body’s natural process of healing itself.
Hays: I have not tried other methods. Though I have not seen much data on the effectiveness of ice baths, my own anecdotal evidence suggests that they are effective. One year at running camp in Colorado, we finished a run around Turquoise Lake near Leadville (elevation 10,152 feet). It was about a 14-mile run, fairly hilly and in the middle of July. When we finished we went down to the snow-fed lake (the water temperature must have been below 60) and soaked our legs. The next day I experienced very little soreness. Since then, I often soak after long runs, and always soak after completing a marathon. I find that I am able to return to my training faster and ramp up my miles again.
Q: Are there exceptions? What about someone who has a minor, nagging injury, for example?
Gillanders: There are always exceptions. People are going to have pain, and ice makes them feel better. Ice can be good for muscles in spasm, or even as a security blanket, if someone has done it all his life.
Pain is usually a sign from the body that something is amiss. You can exercise through slight pain, say zero to three on a scale of 10, as long as it is stable. Pain above those levels usually results in compensations that lead to other problems.
If someone is taking care of himself, with regular stretching and appropriate strengthening, a hard workout is no big thing. In the clinic, I usually see people injured when their bodies are not prepared for the stress of training. Take care of the body and it will take care of itself. Humans did quite well for thousands of years without ice or heat, just the natural healing process, which included lots of movement.
Hays: The body’s natural response to an acute injury is inflammation, to protect the injured area. So to reduce the pain and swelling, I would recommend ice during the first 24 hours. After that, though, it’s time to find the cause of the injury and see a sports therapist. I wouldn’t recommend trying to run through an acute sports injury by just icing after each run. You need to find the cause of the injury.