Winter 2016 – On Ice

It is winter. In Chinese Medicine, this is the time of “storage”. Animals hibernate. The ground is covered with a layer of snow and ice. And humans should all slow down… this might not be the way of the modern world, but it was the way of the world for hundreds of thousands of years, so my advice is to trust your instincts. This is the time of year that donning your pajamas at 7pm is totally acceptable. Just go with it.

So between the season, the ice storm that we were hit with last week, the new “cryotherapy” trend, and MUCH conversation lately about icing injuries and areas of pain, it seems that ice is the right topic for this newsletter….

For years, those of us in Chinese Medicine have winced at the recommendation of ice for injuries, since it goes directly against Chinese medical theory. Cold slows. Heat flows. That is a basic tenet of this medicine. The caveat of that is that too much heat will cause things to dry out, get sticky, and finally stagnate. Once again, we are looking for balance. But cold is pretty much always a problem.

Since ease of refrigeration is a relatively new concept to humans, this ice thing is exceedingly new to our many-thousands-of-years-old human form…. When our bodies sense cold, our physiological processes shift: breathing becomes more shallow to protect the lungs, cardiac output increases, heart rate decreases, muscles involuntarily contract (shiver) to help the body stay warm, and our limbs are sacrificed as blood moves to the core. More information about the physiological effects of cold can be found at http://www.nap.edu/read/5197/chapter/12.

We naturally avoid cold extremes, and yet, our coaches, trainers, and doctors have been prescribing cold to heal injuries for the past four decades. This advice simply goes against our nature.

Ice has been the standard of care in Western Medicine since 1978 when Dr. Gabe Mirkin wrote The Sportsmedicine Book. In it, he coined the term R.I.C.E., which stands for Rest, Ice, Compression, and Elevation. The intent of these activities is to prevent further injury, and reduce pain and inflammation. Unfortunately, they do not meet their intended goals, and RICE often creates an environment for chronic pain. Evidence is now emerging that the use of ice on acute injuries may actually delay the healing process, a case where Western scientific evidence is finally catching up with the wisdom of Chinese Medicine.

As someone who has had her share of injuries and a couple significant joint surgeries, I spent a lot of time with ice packs. Once I started studying this medicine, it began to really frustrate me that ice is so widely recommended for prolonged periods following trauma and especially for those who struggle with chronic pain. A fundamental principle of Chinese Medicine is that all pain is caused by stagnation, and healing occurs through the restoration of movement or flow (circulation). This is an important concept for everyone to understand – both laypeople and medical practitioners. Every aspect of RICE aims to inhibit flow.

In the case of a sprain with swelling, the stagnation is initially quite pronounced. The natural inflammatory response is to send more blood and fluid to the area to protect the joint and fix the problem.

The build-up of fluid (swelling) at the site should be considered a positive reaction as it increases sensitivity to pain (to prevent further injury), restricts movement (to prevent further injury) and allows the inflammatory process to progress (to help repair the injured tissue).

Anything that blocks our natural immune response will delay healing – in addition to ice, this includes cortisone, anti-inflammatory drugs including NSAIDS / ibuprofen, or immune suppressants.

Acupuncture, bleeding techniques, cupping, and gua sha all promote flow, greatly speeding up the healing process. Topical liniments and herbal medicine will further enhance healing.  Depending on the nature of the trauma, we also encourage the patient to *gently* move the affected area.

Movement promotes clearance of cellular debris and accumulated lymph. It brings in a greater supply of oxygen and nutrients, and also ensures more constructive healing, less scarring, and more functional scar tissue.

Not only have innovative trainers and medical practitioners begun to question the validity of RICE, even Dr. Gabe Mirkin himself recently wrote an article called “Why Ice Delays Recovery (http://drmirkin.com/fitness/why-ice-delays-recovery.html).

It has now been many years (and sadly, several more injuries) since I last reached for an ice pack, so I do not believe that ice is ever “necessary” following injury, but if you feel you must ice an injured area, keep it to the first 24-36 hours post-trauma.  And for any chronic pain situation, please do yourself a favor a stay far away from ice.  It will numb the pain in the short term but exacerbate the problem long term.

This is a tough one, I know.  When I was in school, learning about the damage ice causes was right up there with the advice to not eat too much fruit (fruit sugar is still sugar), don’t consume anything cold (particularly iced coffee – at the time it was my favorite daily treat), and too much exercise is ultimately detrimental (this was shocking to me)….  Common sense (and modern research) tells us that these things are true.  It’s just a matter of believing what you already know.

2017-09-18T18:03:15+00:00