Ice Age: Rethinking Icing Injuries and Sore Muscles

I remember when I went to the nurse in high school for a medley of ailments, and it seemed like no matter what the symptom was, a pack of ice was the associated prescription. Headache? Put ice on it. Muscle pain? Put ice on it. The building was on fire? Throw ice on it. Okay, the last one was a pretty lame joke, but somehow ice became a panacea in my nurse's eyes. It seems that in the sport and exercise world, such is also the case.

Ice Baths for Recovery

I just started watching Game of Thrones,
and I couldn't resist using this meme...

The most common use of ice that I hear people tout is its recovery healing powers. Are torturous ice baths as effective as we make them out to be?

We have evidence of the early Egyptians using early forms of cryotherapy in 2,500 BCE to treat a medley of ailments. Fast forward to 2018 and you see people immersing themselves into futuristic-looking cryotherapy chambers filled with liquid nitrogen. As you can imagine, extensive research on the subject has been done since ancient Egyptian times.

Now, one study done by Fonda and Sarabon (2013) did find that participants who utilized whole body cryotherapy reported feeling less sore than those with no intervention. While this is more qualitative rather than quantitative evidence, it does show the potential for a decrease in the perception of DOMS with cold immersion.

Hausswirth et. al. tested runners and also found a reduction in pain and subjective fatigue 24 and 48 hours after their runs in participants using cryotherapy chambers. While this is also a qualitative measurement, researchers also found an increase in strength when compared with the control group (2011).

Contrarily, Costello et. al. measured MVC (maximal voluntary contraction of a muscle) 24 hours after an eccentric exercise protocol and found no significant differences in muscle soreness in participants who were immersed in -110° C temperatures and those who weren't immersed (2012). 

Overall, the current body of research does seem to suggest that cold immersion can help reduce subjective measurements of fatigue and soreness in athletic populations, but the verdict is still mixed as far as I'm concerned. Many of the measurable, physiological markers of recovery were unchanged, but the participants simply reported feeling better. My thought process is that a lot of the attributed markers of recovery are due to a placebo effect. Effectively, if you feel like an ice bath helps you feel like you're being active in the recovery process, then keep on as you were. It may not be efficacious, but it's worth a try!

Ice Baths for Treating Injury

Going back to my high school nurse who would use ice as a cure-all, many people still assume that icing is the best protocol for soft tissue injuries. Let me start by saying that ice works as an anti-inflammatory and also a vasoconstrictor (meaning your blood vessels constrict). The downside here, is that we societally regard inflammation as a negative thing, when it is in fact your body's line of defense. Inflammation is necessary to jumpstart the healing process. The more blood flow you get to an area, the quicker the repairing process can start. Gary Reinl, author of the book "Iced" which covers this topic more in-depth, notes "the inflammatory cells remove debris and recruit cytokines and other growth factors toward the injury site." As such, swelling and inflammation are not symptoms to fear or reduce in this case. He goes on to say, "In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase. The fibroblasts build a new extracellular matrix and persist into the final phase of repair, the maturation phase, where, if all goes well, functional tissue is laid down. The key point is that each phase of repair is necessary for the subsequent phase."

Additionally, the University of Pittsburgh Medical Center (my alma mater) noted that "…ice may not be the best treatment for aching muscles — in fact, it could even be detrimental to recovery" (2011). The British Journal of Medicine reached a similar conclusion, stating that "ice is commonly used after acute muscle strains but there are no clinical studies of its effectiveness" (2012).

Summing it All Up

Icing injuries has become a staple in workout and recovery protocols for people all across the globe for ages. As it turns out, the effectiveness as icing for both decreasing muscle soreness/damage and for aiding in the healing process of an injury seems to be unfounded. The body of research denouncing the usage of ice on both accounts seems to outweigh the papers that support its application.

I personally don't use ice in either instance, and I believe that rest, sleep and proper nutrition can be some of the most effective recovery strategies! Next time you go to jump into the ice bath or wrap an injury in a bag of ice, ask yourself why, and decide whether or not it's actually going to help you or potentially hinder you.





Works Cited:

1. Costello JT, Algar LA, Donnelly AE. Effects of whole body cryotherapy (−110°C) on proprioception and indices of muscle damage. Scand J Med Sci Sports. 2012;22:190–198.
2. Fonda B, Sarabon N. Effects of whole-body cryotherapy on recovery after hamstring damaging exercise: a crossover study. Scand J Med Sci Sports. 2013;23:e270–e278.
3. Hausswirth C, Schaal K, Le Meur Y, et al. Parasympathetic activity and blood catecholamine responses following a single partial-body cryostimulation and a whole-body cryostimulation. PLoS One. 2013;22:e72658. 
4. Reinl, Gary. Iced!: the Illusionary Treatment Option. Gary Reinl, 2014.
5. Van den Bekerom, Michel P.J et al. “What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?” Journal of Athletic Training 47.4 (2012): 435–443. Print.

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The "Lactic Acid" Myth

After a tough workout, I will hear people brag, "Oh man, that lactic acid is killing me! I'm so sore!" I want to use this post to dispel the myth that lactic acid is what causes DOMS (delayed onset muscle soreness). Yes, you read that correctly. The age old belief that lactic acid was the cursed substance that leaves you hobbling up the stairs after your crazy leg day is actually false.

How did this inaccuracy come to be? Gina Kolata, journalist from the New York times writes:

"Its origins lie in a study by a Nobel laureate, Otto Meyerhof, who in the early years of the 20th century cut a frog in half and put its bottom half in a jar. The frog's muscles had no circulation — no source of oxygen or energy. Dr. Myerhoff gave the frog's leg electric shocks to make the muscles contract, but after a few twitches, the muscles stopped moving. Then, when Dr. Myerhoff examined the muscles, he discovered that they were bathed in lactic acid. A theory was born. Lack of oxygen to muscles leads to lactic acid, leads to fatigue."

Scientists actually believe that lactic acid is not even present in humans. While the blood does become more acidic during exercise, the acidity is not enough to create lactic acid, but rather, lactate is created.

While some industry professionals use the words 'lactate' and 'lactic acid' interchangeably, there is a slight difference between the two substances. "The formation of lactate from pyruvate is catalyzed by the enzyme lactate dehydrogenase. Sometimes, mistakenly, the end result of this reaction is said to be the formation of lactic acid. However, at physiological pH (i.e. near 7), the lactic acid molecule cannot exist. Instead, it’s anion lactate- + H+ (a hydrogen proton) are the results of the lactate dehydrogenase reaction," according to the National Strength and Conditioning Association's Essentials of Strength and Conditioning. For true lactic acid to exist, the blood pH would need to drop below a 4.

Lactate is, however, a fuel for the muscles. An athlete's lactate threshold is the point at which his or her body produces lactate faster than it is cleared. Lactate is not a waste product, nor is it something to avoid, despite the fact that "lactic acid" (lactate) gets a bad rap.

It's not lactic acid's fault!

Although the cause of muscular soreness is still not entirely understood by science today, the residing theory is that soreness is really the result of micro-tears of the muscles after exercise. When you do a new exercise, or you increase the intensity (weight) and/or volume (repetitions) of a movement, your tissues suffer from micro-traumas. Lactate is rushed to the muscles to clear away the damage, but it is the muscular damage that causes the pain, not the lactate itself!

So the next time you hear someone curse lactic acid for their temporary post-workout induced paralysis of the legs, you can spit a little bit of science at them, and explain to them what's actually causing their soreness.


Works Cited:

1. Baechle, Thomas R., and Roger W. Earle. Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics, 2008. Print.
2. Brooks, George, and Rhonda Patrick. "Lactate As Brain Fuel with Dr. George Brooks." YouTube. N.p., 02 Dec. 2014. Web. 27 Apr. 2016.
3. Hutchinson, Alex. Which Comes First, Cardio or Weights?: Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise. New York: HarperCollins, 2011. Print.

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Check out Melinda's Blog Post This Week:

We all get injured at some point during our fitness journey. Check out Melinda Prince's blog post this week about injury prevention and treatment. Click here to read!

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