Monday, November 12, 2012

The Case Against Ice-Why Inflammation Can Be Good

Let me begin by stating the fact that I am not a physician or have any sort of medical training whatsoever.  This post is purely my opinion based on careful thought and observation.  

Now that we have that disclaimer out of the way we can get down to my latest crazy talk.  I'm sure this won't surprise anyone who knows me.  I ran barefoot to relearn how to run naturally.  I don't believe in arch supports or cushioning to the chagrin of my multiple doctors.  I quit using anti-inflammitories last year for my arthritis because of this article.  I have chickens roaming my backyard.  Half of my backyard is a vegetable garden.  I have 2 beehives.  I had a Ron Paul sign in my front yard for most of the year.  So I'm not exactly what you would call normal.  But I don't think I'm really crazy either.  Maybe I just think about things too much.  

Shortly after I rolled my ankle and the swelling was spreading from the outside of my ankle to the inside of my ankle and the top of my foot, I was sitting on the couch with an ice pack.  And I got to thinking.  Why does the body inflame the part that's been injured?  I knew it had something to do with increased blood flow and fluid, but why exactly does it do that?  And more importantly, why do we try to stop it?  We are repeated told to RICE (rest, ice, compress, and elevate) and to take copious amounts of vitamin I (ibuprofen).What are we trying to fight here?  So I did what any person would do and googled it.  (Dr. Google and I are pretty tight.)  I found pretty much the same answer every place I looked.  Here's an example:

A localized protective response elicited by injury or destruction of tissues, which serves to destroy, dilute, or wall off both the injurious agent and the injured tissue. adj., adj inflam´matory.  

The classic signs of inflammation are heat, redness, swelling, pain, and loss of function. These are manifestations of the physiologic changes that occur during the inflammatory process. The three major components of this process are (1) changes in the caliber of blood vessels and the rate of blood flow through them (hemodynamic changes); (2) increased capillary permeability; and (3) leukocytic exudation.

Hemodynamic changes begin soon after injury and progress at varying rates, according to the extent of injury. They start with dilation of the arterioles and the opening of new capillaries and venular beds in the area. This causes an accelerated flow of blood, accounting for the signs of heat and redness. Next follows increased permeability of the microcirculation, which permits leakage of protein-rich fluid out of small blood vessels and into the extravascular fluid compartment, accounting for the inflammatory edema.

Leukocytic exudation occurs in the following sequence. First, the leukocytes move to the endothelial lining of the small blood vessels (margination) and line the endothelium in a tightly packed formation (pavementing). Eventually, these leukocytes move through the endothelial spaces and escape into the extravascular space (emigration). Once they are outside the blood vessels they are free to move and, by chemotaxis, are drawn to the site of injury. Accumulations ofneutrophils and macrophages at the area of inflammation act to neutralize foreign particles by phagocytosis.

A less complicated explanation is this:

Inflammation is the body's attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens - and begin the healing process. When something harmful or irritating affects a part of our body, there is a biological response to try to remove it, the signs and symptoms of inflammation, specifically acute inflammation, show that the body is trying to heal itself. 

So after reading those explanations of inflammation, I wondered why we try so hard to fight this response from our bodies to try and heal itself.  Maybe inflammation is good.  Yes, it causes pain and we don't like pain.  But what if pain is good?  Like the kind of pain that protects you from injuring it further, from overextending it.  We try to fight pain, but maybe we shouldn't as much.  

After the explanations was this list of treatments:
  • Ice is the best treatment.

    • Applying ice to the injury will help decrease pain.

    • Ice counteracts the increased blood flow to the injured area.

    • It reduces swelling, redness, and warmth.

    • Applied soon after the injury, ice prevents much of the inflammation from developing.

I don't want to confuse acute inflammation with chronic inflammation that destroys healthy cells such as in Crohn's disease, asthma, rheumatoid arthritis, or ulcers.  I understand that kind of inflammation is not good.  But after an injury or any kind of trauma to the body, it seems that inflammation is just trying to help our bodies recover faster.  Why are we trying to fight the bodies response to bring blood in, and take the bad stuff out?  Is the main reason to fight pain?

Check out this study by neuroscientists at the Lerner Research Institute at the Cleveland Clinic in Ohio. The title:  Inflammation helps to heal wounds- Surprise Discovery.

And check out this blog post by MobilityWOD about why he is convinced icing is bad and will become a thing of the past.

After thinking and doing some research, I quit icing.  In fact I only iced twice.  My swelling is almost gone.  And boy did it swell and bruise.  The bruising is almost gone as well.  I'm not limping anymore, although I think I'm still a ways from being able to run again.  Going down stairs and sitting cross legged is still painful.  I did go to the doc and have an x-ray taken to see if I had broken anything.  I didn't.  And I disobeyed my doctor when he told me to ice it and take Celebrex.  Whether not icing has actually helped or hinded my healing is yet to be seen.  But I like the idea of bucking the system especially when it makes sense to me.  

What do you think?
Wouldn't you love an excuse to quit taking those ice baths?
Do you have a good answer to my questions?  
Do I just not understand this stuff correctly?


Cory Reese said...

You make some great points. I work at a dialysis center and see first-hand what can happen when people take too many anti-inflammitories like Advil or Aleve (those can really screw up kidneys).

Thanks for this info!

Yo Momma Runs said...

I've read that anti-icing article before and thought it was very intereresting. My icing habits are strictly anecdotally based. I had good experiences with icing after a mild foot injury, so I do it whenever I feel like it. I agree that our bodies are meant to work out kinks on their own, but even though I rarely take antibiotics, I usually do some herbal treatments if I feel a cold coming on, just to give my body an extra boost. I see icing like my herbal remedies, a natural way to promote healing. I still stay away from ibuprofen to reduce swelling. Wow, long comment to basically say I'm still a fan of icing even though I get why some people don't think it's necessary.

Jeano said...

How interesting! I hadn't heard about icing before, but I've read similar things about stretching and haven't stretched in over a year (it's possible I was just looking for an excuse not to do it because it's the most boring thing ever, but still!) and have been happy with that decision. As for ice, I DO feel like it's been helping me with this shin pain I've been having, but it also makes sense to me why it could be useless... hard to know!

Michael said...

I must admit I like to ice if the injury warrants. I never stretch and I know that's an issue. My physiotherapist told me that at the very least take a yoga-for-runners class in the last 6 weeks of my training for a full mary. My son bought me an arch shape-half-moon contraption fro stretching my calf. It really good and seems to help. Trouble is I use it AFTER the injury... but I'm learning! Thanks Jen. Good luck with the ankle. It looks like a nasty one! Love your blog.

Noel Nelson said...

Ice is the natural way to promote healing. Bruising and swelling immediately reduces with ice.Ice baths are also very effective in increasing blood circulation.


Michael said...

Hi Jen :) mike