Does Icing Work for Sore Muscles?
Get-Fit Guy looks at the science behind icing sore muscles, plus has tips on how to make the most of Rest. Ice. Compression. Elevation.
Ben Greenfield
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Does Icing Work for Sore Muscles?
Cryotherapy may sound like something out of a science fiction novel, but it’s actually something you’ve done before if you’ve ever iced a sore ankle, taken a plunge into a cold shower or bath, or shoved your hand into ice water after touching a hot stove. It’s simply the use of ice or cold as “therapy.” Of course, you can get very scientific with cryotherapy if you would like. For example, few months ago, when I was at a health and fitness conference, I actually tried a more advanced form of cryotherapy in which my body was immersed in a subzero temperature chamber for 3 minutes. You can watch the video series from that chilling experience.
In this case, the cryotherapy immersion was meant to boost my metabolism, assist with fat-burning, and improve sleep. But in today’s episode, we’re going to focus on perhaps the most convenient, useful, and pleasant form of cryotherapy – icing sore muscles. And you’re going to learn whether icing muscles really works for soreness, along with the very best way to ice..
Icing for Recovery
In the episode How to Recover After a Workout, you learn about using techniques such as nutrition, hydration, compression, blood flow, and topical ointments to limit the annoying muscle soreness that you often experience after lifting weights, running, or exposing your muscles to other potentially damaging activities.
Icing and cold exposure are also among the sore muscle recovery methods I personally use on a regular basis. On my blog, BenGreenfieldFitness.com, I’ve written comprehensively about the advantages of cold thermogenesis, including the multitude of performance benefits derived from frequent exposure to cold temperatures and cryotherapy such as cold water immersion, cold showers, cold-hot contrast showers, or use of body cooling gear such as the Cool Fat Burner vest or 110% Compression Gear. The benefits of all these cooling techniques include enhanced immune system, increased cell longevity, decreased level of inflammatory molecules such interleukin-6, and of course, decreased soreness.
The application of cold to a sore muscle is hardly a new concept. The Greek physician Hippocrates wrote about the use of cold therapy to control pain and swelling in the 4th century B.C., and the Roman physician Galen described the use of cold compresses for pain management following soft tissue injuries in the 1st century A.D.
There are even studies that are commonly cited in the argument against icing.
During the Middle Ages, ice was used for pre-surgical anesthesia, and ice therapy has been extensively used in athletic training facilities and physical therapy clinics for the treatment of sports injuries. But despite the seeming widespread acceptance of tossing a bag of ice on an injured ankle or aching shoulder, there is lately a sudden doubting of icing’s efficacy.
The argument goes something like this: When an injury occurs, your body creates inflammation as a healing response. So if inflammation is the body’s natural way to heal an injury, why would you want to block this inflammatory process with ice?
It has also been claimed that icing may increase the permeability of lymphatic vessels (the tubes in your body which normally help carry excess tissue fluids back into your cardiovascular system). Once this lymphatic permeability increases, there may be risk of a large amounts of fluid backflowing into the sore area, causing more swelling than may have occurred if you didn’t ice in the first place.
And there are even several studies that are commonly cited in this argument against icing.
The first study commonly cited is “The Use of Cryotherapy in Sports Injuries.” But if you look closely at this study, the researchers simply conclude that “cold can inhibit inflammation as well as enhance inflammation.” It certainly is true that when ligament injuries were induced in pigs (this is similar to the type of injury you might get when weight training), swelling was greater in ice treated limbs. However, in this study (as well as in another study entitled “Cryotherapy Influence on Posttraumatic Limb Edema”) animal subjects were subjected to long periods of icing up to 1 hour in length. And a full hour of icing is a period of time that you’d be hard pressed to find any sports medicine professional recommending.
In addition, in the first study I just mentioned, it was demonstrated that permeability of the lymph vessels does actually increase with icing, but that within 25 minutes after icing, the permeability of the lymph vessels returns to pretreatment levels. Finally, it was simply ice used in both these studies – with no compression (pressure) or elevation (two other injury protocols that are highly recommended by sports medicine professionals). The majority of studies that combine ice with compression and elevation do not show the same permeability increase or resultant swelling with cold treatment. This is because compression from pressure placed upon an injured area reduces swelling and prevents fluid from leaking out of the vessels.
Of these 10 studies, 6 were trials in humans, but 4 of them were thrown out because of poor research!
Another study commonly cited in the argument against icing is the 2008 study “Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?” This was basically a literature review of 10 studies. Of these 10 studies, 6 were trials in humans, but 4 of them were thrown out because of poor research. The additional 2 human studies were split, with one of them supporting cooling, while the other lacked statistical significance to show icing’s efficacy. Four animal studies in this review showed reductions in swelling from ice application. The final two pieces of literature cited were systematic reviews, one of which was inconclusive and the other suggesting that ice may hasten return to participation. None of these results justify tossing your ice bags into the trash bag, but again simply suggest that icing by itself may not work in some cases.
Finally, a 2010 study was performed at the Neuroinflammation Research Centre at the Cleveland Clinic in Ohio, and was instantly heralded across the press as conclusively revealing that “putting ice on injuries can slow healing.” But laughably, a closer look at this study reveals that no ice or cold treatments were used at all! Researchers simply studied two groups of mice: one group that was genetically altered so they could not form an inflammatory response to injury, and a second group that was normal.
The researchers then injected the mice with barium chloride to induce muscle injury, and found that the mice who were genetically altered to not form an inflammatory response to injury did not repair their damaged muscle. So this research simply demonstrated that the complete absence of inflammation will shut down the muscle healing response – but did not investigate the effect of ice at all! This is clearly an example of How the Media Sensationalizes Science.
So what we have learned so far is that icing sometimes works and sometimes doesn’t – and the times that icing doesn’t work is when you ice for very long periods of time or when you ice without also using pressure or elevating the area you’re icing.
Can Ice Reduce Swelling and Soreness?
One of the reasons you get so sore after a workout is from swelling – and the subsequent pressure placed on nerves and tissue from that swelling. Prevention of excessive swelling is important because fluid that has escaped into the tissues from excessive swelling can create a low oxygen (hypoxic) environment that can lead to additional tissue damage and delay healing. In addition, swelling can cause distention in joint capsules and other tissues, and excitation of nervous system components called mechanoreceptors – which can also increase pain and soreness.
But the benefits of icing don’t stop with the ability to control excessive swelling. For example, the cold temperature of ice can slow down nerve conduction velocity and shut down the activation of protective muscle reflexes, making ice a highly effective pain reliever and muscle relaxant. If a muscle is in less pain and is more relaxed, then mobilization and movement become a reality, and you can get back to the next workout more quickly.
Ice also reduced metabolic activity in the tissues that are iced, making them better able to resist the damaging effects of loss of oxygen from inflammatory swelling pressure. In other words, lower tissue temperatures from icing means less oxygen is required by those muscles to sustain their integrity.
When you ice, you also experience what is called a “Hunting reflex,” in which your vessels pump of inflammatory and metabolic byproducts out of an injured area, while allowing additional healing components such as macrophages and white blood cells to mobilize into the area for speeding up healing and reducing soreness. When combined with pressure and elevation, this “pumping” action of ice can be an extremely effective workout recovery tool.
How to Ice Sore Muscles
If you have an actual injury, icing can (and should) be initiated as soon as possible after the event, for a duration of 20 to 30 minutes. You can use frozen ice cups, ice baths, crushed ice, frozen vegetables in a plastic bag, or one of my latest finds, a convenient pack of FrozenPeaz.
But for overall muscle soreness that isn’t caused by a localized injury, ice immersion works much better, and can be accomplishied by spending 15-20 minutes in a cold bath (don’t worry – it doesn’t have to be teeth-grittingly cold – 55 degrees is just fine) or by taking a cold shower. By doing so, you’ll also get all the other benefits of cold thermogenesis.
If you have more questions about icing sore muscles, paste them in Comments or go to https://www.Facebook.com/GetFitGuy!
Check out my book Get-Fit Guy’s Guide to Achieving Your Ideal Body for tips on the fastest way to your dream shape.
About the Author
Ben Greenfield received bachelor’s and master’s degrees from University of Idaho in sports science and exercise physiology; personal training and strength and conditioning certifications from the National Strength and Conditioning Association (NSCA); a sports nutrition certification from the International Society of Sports Nutrition (ISSN), an advanced bicycle fitting certification from Serotta. He has over 11 years’ experience in coaching professional, collegiate, and recreational athletes from all sports, and as helped hundreds of clients achieve weight loss and fitness success.