Written by: Jason Schreiber, Owner of Top Tier CrossFit
We’ve all experienced soft tissue injuries. Maybe it was your hamstring during a run. Maybe your shoulder went out during your bench press, or when you were throwing a ball with your children. You go to your primary care physician, and what advice do they give you? It probably went something like this, “take this 800 milligrams of Ibuprofen 3 times a day, and rest and ice your injury until it feels better.”
You likely got better, but it took 4 weeks before you really felt 100%. What if I told you there was a better way? What if resting and icing was slowing down your healing? What if it’s all been a myth perpetuated over the last several decades?
The man credited with creating the R.I.C.E. (Rest, Ice, Compression, Elevation) protocol for soft tissue injury is Dr. Gabe Mirkin in his 1978 publication, “The Sportmedicine Book.” Then in March of 2014, he shocked the medical and fitness world by recanting his statement. In his self published article on his website he revealed, “There really wasn’t too much science and no one understood very much [about icing]. Since then, I’ve noticed that several studies have come out that showed the ‘R’ and the ‘I’ are just incorrect.”
Dr. Mirkin went so far as to write the foreword to Gary Reinl’s book, “Iced!: The Illusionary Treatment Option.” Gary Reinl was a journalist who set out on a mission to uncover how best to use ice for healing, because he was frustrated with the observation that there was not a medical consensus on how, when, and why to use ice after injury. In his book, Dr. Mirkin and he both explain that not only does icing not speed up healing, but that it actually slows down the healing process and causes further tissue damage. They explain that icing after injury slows healing in the following ways:
Icing slows inflammation. You’ve probably been told that this is a good thing. However, open any physiology book and you’ll see that the three necessary steps to healing are: Inflammation, remodel, and repair. Icing prevents the release of a hormone called IGF-1 in the localized tissue that is necessary for the remodeling process to start.
Icing prevents healing cells from entering the damaged tissue. Ice is a vasoconstrictor, which means it shrinks the diameter of the capillaries in the tissue, preventing the flow of blood and lymph into that area. A smaller tube means the good stuff can’t get into the area, and it also means the bad stuff can’t get out!
Icing causes additional tissue damage. Bringing the temperature down low in the injured tissue can kill healthy tissue cells around it. It’s like taking a shotgun to the area instead of a sniper rifle. You can’t prevent the collateral damage.
Icing increases swelling. Once you’ve cooled the area and caused the vasoconstriction, the body responds with a rebound effect, shuttling more pressure and fluid into that area in an attempt to raise the temperature and pressure back to homeostasis. In effect, you directly cause an increase in the very thing you were hoping to lessen.
Icing shuts off the body’s signals that alert you to harmful movement. Ice effectively numbs the area, which means you could easily perform movement that damages the tissues without even knowing it until after the local temperature has returned to normal. The analogy is similar to why you need pain signals to prevent keeping your hand in a flame. Pain tells you to stop doing something. If you are numb...you can’t feel those signals,which increases the likelihood of greater acute tissue damage during movement while the temperature is so low.
So if icing and rest are the enemies of tissue healing, what can we do to speed up the healing process after injury? The answer is simple. MOVE! More specifically, move without triggering the pain response. If we cause pain, we MAY be causing more tissue damage (this is debatable, but we'll save that for another article). So the key to healing is frequent, painless, low intensity movement of the surrounding soft tissues and joints.
This painless movement speeds healing in the following ways:
Increased blood circulation. The healing cells are being shuttled to the damaged tissue through dilated blood vessels and capillaries. The wider the vessel diameter, the more soldiers get to the fight. This is literally the opposite of what happens if we ice the area instead.
Increased lymphatic circulation. Your lymphatic system uses your muscle contractions as a pump, while your blood uses your heart as it’s pump. The lymphatic system is used to remove the waste products from the damaged area. Without the muscle contractions happening frequently, you cause pooling of those waste products and delay healing. Resting the area and icing literally causes the pooling of that waste to happen faster, delaying healing.
Increased hormonal activity. We mentioned things like IGF-1 earlier. The more painless movement you perform, the better the hormonal environment to facilitate the recovery process.
But what kinds of movement should we perform? Ideally these movements should be simple, with low levels of skill. This makes them easy to learn and hard to mess up. They should also have very little eccentric contraction, because this is the main form of contraction that causes muscle damage. If we are already injured, why would we want to further damage the surrounding tissues with heavy eccentric contractions? And finally, movements should provide a fluidity in their performance, allowing the person to maintain low intensity, painless movement for longer period of time to encourage healing.
Some examples of low intensity, low skill, low eccentric exercises might be:
Sled push/ pull
Biking/ Rowing/ Swimming
Carries (back, front rack, overhead, unilateral, bilateral)
Drags (sandbags, kettlebells, ropes, etc)
Bodyweight movements (squats, lunges, pushups, bird dogs, 90/90 drill, dead bugs, locomotion drills)
Isometric movements (planks, bridges, holds)
Obviously, it should go without saying that learning and perfecting these exercises should occur in supervision with a qualified personal trainer or strength and conditioning coach. Ideally you find someone who has dedicated their lives and career to prioritizing good technique and intelligent programming. Avoid the hobby trainer who simply has a weekend certification or two. And this coach/ trainer should be eager to coordinate your exercise program with your physician, chiropractor, or physical therapist. Any coach who avoids partnering up with your doctor is not interested in acting on behalf of your best interests.
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