To Ice or Not to Ice?

There has been debate in the media recently about the effectiveness of icing after injury. Questions regarding the correct application of icing are also often posed in the clinic, so I thought we could chime in on the topic.
This is an exerpt from a research paper completed by our recent Kinesiology Co-Op student, Katherine (Katy) Moes:

"Cryotherapy, or the application of ice to an injured area, is a treatment commonly used by both clinicians and the general public. However, there has been some recent debate regarding the true efficacy of this treatment. The purpose of this report was to examine the relevant literature on this topic, working towards an evidence-based protocol for administering cryotherapy to individuals in a clinical setting. This report specifically examined cryotherapy as it pertains to members of the general adult population who have sustained acute soft-tissue injuries.
The literature reported that there is sound physiological theory explaining why cryotherapy may be effective. It may induce vasoconstriction, reducing blood flow to the area and thereby reducing swelling and edema. It also may reduce pain and muscle spasms. However, the literature did not show cryotherapy to have a significant effect on the healing process. The research also did not produce a consensus on the optimal frequency, duration or type of cryotherapy application.
Despite the lack of consensus and significant experimental findings, cryotherapy has been anecdotally shown to be effective. The best recommendation this project can offer is to apply ice to an injured area as soon as possible after the injury occurs, for sessions of 10-20 minutes with full re-warming time between sessions. In order to confidently state that cryotherapy has a significant effect on the rehabilitation of acute soft-tissue injuries, many more high-quality studies would be needed."

For me the take home from Katy's research is that there is no scientific evidence that icing works to help an injury heal more quickly. There is also no concensus on appropriate icing parameters. I have had one colleague recommend its use for as little as 4-6 hours post injury based on recent findings, as opposed to the traditional recommendation of 24-48 hours. Although the theory that icing helps decrease inflammation seems sound, I have also heard the theory that long term icing may actually decrease the lymphatic system's ability to reduce local fluid. And then there is the question as to why we think we need to reduce inflammation anyway. It is an important step in the healing process! (see another colleague's indepth blog on this topic http://www.aptei.com/articles/pdf/Ice-NSAIDs-Paper.pdf)

Take home? If icing helps reduce discomfort, by all means go ahead and apply it immediately after injury (10-20 minutes with complete warming between sessions for a maximum of 24 hours after injury)... just don't expect it to speed up your recovery!

Photo courtesy of wisegeek.com

Overtraining

I once had a very wise track coach say to me “it is better to under train than to over train.” I thought this phrase was pertinent as we enter peak road race season and as I prepare for my own upcoming half marathon. Because really, what is the benefit of training too much? The whole purpose of training is to force our body to adapt to the demands that we place on it. However if we place too many demands on it too quickly, our bodies will be unable to adapt in time for the next workout. The consequences can take the form of reduction in performance, illness and of course injury.

Some general guidelines for increasing training are as follows:

Volume increases should be limited to 10% per week (5-10 minutes total is a good guideline)

Intensity should be limited to 3% per week (for example the number of intervals or hills should be increased very slowly and only add or increase ONE of those per week)

Surfaces can affect your increases as well: a cross country run without hills will be easier to increase your volume on. Changing from one surface to another; including treadmill to ground should be done gradually as well. After all, your body has adapted to the surface you have been training on and a harder surface will affect joints, tendons and muscles differently! You may want to start with only part of your workouts on the new surface. Also in the vein of surfaces, avoid running on the same side of the road or sidewalk since they are graded for drainage and therefore create uneven forces on your body.

Finally…. Running shoes… The ongoing debate continues and is probably the topic of another whole blog entry. But please be skeptical of information that is given. Most of the current advice is based on research that is done by the shoe company!!! My rule of thumb is that if you are susceptible to posterior chain injuries (foot pain, plantar fasciitis, Achilles tendinopathy, even hamstring and glute issues) stay away from more minimalist shoes and change shoes every 3-6 months depending on how much training you do. For back, knee and shin issues, stay away from the big bulky shoes. Again, slowly integrate the new shoes as well. Use for walks initially, then short runs then your longer runs to allow your body to adapt to them.

In conclusion, look for early signs of over training; niggling pain as well as difficulty sleeping and irritability that may go under the radar. Take a step back… pushing through may only lead to problems!!