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To Ice or Not to Ice?: External Applications for Injuries and Pain

By Dara Cantor, MAcOM, LAc


One of the first things many of my patients hear from me when they present to my office with sprains, strains, arthritis, or other musculoskeletal injuries is “Don’t ice it!” Influenced by Chinese traditional medicine theory, I am a strong proponent of heat packs rather than cold packs for injuries, beyond the first 24 hours after a fracture or sprain. Ice can be helpful in numbing pain and reducing swelling directly after a trauma, but can slow or halt the healing process if used repetitively. It turns out that modern research is increasingly supporting this move away from the habitual icing of injuries, and I’d like to present some of the reasoning behind this shift.

  • First, the inflammatory process is necessary for healing. Increased blood-flow to an injured area ushers in cells necessary for repairing and remodeling tissue, and inflammatory cells release growth factors that stimulate new cell growth. An expanded vascular network also creates pathways out of the injured site for cellular debris. Ice by its nature is constrictive, and it decreases blood-flow to an area. It inhibits inflammation, and over time this can hamper the healing process.
  • In order for an injured area to heal, there must be proper collagen alignment, proper nerve firing and coordination of muscle movement, and new cell growth, all of which are impeded by ice application. In Chinese medicine terms, cold slows movement and activity, which ultimately slows the healing process. A balanced level of warmth or heat encourages movement, growth, circulation, and ultimately vitality.
  • The swelling that results from inflammation can be problematic, but it is best reduced by increasing lymphatic drainage, rather than stopping the inflammatory process all together. There are a number of ways to increase lymphatic drainage, one of which is acupuncture. Two of the many physiological effects that acupuncture has been found to have on the body is to increase lymphatic drainage, and to speed tissue reparation and regeneration. Additionally, internal herbal formulas and topical herbal poultices or soaks are used by traditional Chinese medicine doctors to reduce local swelling without ice.
  • We often think of chronic injuries like tendonitis or arthritis as areas of chronic inflammation. In reality, an injury that has not healed for months or years almost certainly involves some level of degeneration of the joint or soft tissue, and very minimal remaining inflammation, if any. Chronic tendonitis is more accurately labeled “tendonosis,” meaning dysfunction rather than inflammation of the tendon. Again, in order for such an injury to improve, circulation and tissue regeneration are key, and they are better promoted by heat than cold.

My recommendation for most injuries and cases of chronic pain is to try acupuncture for a course of treatment to encourage healing of tissue and/or bone, apply heat packs to the area several times a week or more, exercise the area at a comfortable level that does not induce pain, and do at-home exercises prescribed by your Acupuncturist, Physical Therapist, or Chiropractor geared at re-balancing your musculoskeletal system to support healing and prevent re-injury. The specific acupuncture treatment recommendations and at-home exercises will vary depending on the injury or complaint. But in any case, resist the urge to numb your pain for 20-30 minutes with ice while potentially slowly the healing process in the long term! For more information on this topic, or if you are interested in trying acupuncture to treat a pain condition, please feel free to contact me through the clinic.