♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Howdy, folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Today, we're gonna talk about should you stop icing?
Are you delaying healing by doing so?
- So we're talking about cold packs.
- Yep, we'll get into it.
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Is this is gonna be on a podcast?
- No. - No.
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Bob, we could make this a podcast.
Nevermind. - Well, of course.
- This is a podcast.
- We're on the fly today. Let's get moving.
- Okay. So, we're definitely undecided on this yet.
I'm listening to the arguments
and I'll certainly think about it
and I'll maybe take it case-by-case,
case-by-case issue.
I'll look at it.
- Right, 'cause historically we've both
been pretty big proponent of-
- Of icing. - Of cold pack, ice packs,
which I think was across the board over the years.
- Yeah, in fact, you use ice a lot, Brad,
for your chronic pain, your spondylolisthesis.
- Right, back pain, yep.
If I do something that I shouldn't be doing-
- And you feel it really helps.
- I have a cold pack in my freezer
and it's available 24/7.
Not that I use it a lot, but it's not unusual either.
- So the argument was presented by Gary Reinl.
I hope I pronounced his name right.
R-E-I-N-L.
He's the author of "ICED! The Illusionary Treatment Option."
Now, the other person that supports this is Kelly Starrett.
We've had him on our podcast.
- Sure. - Kelly Starrett.
And he's a best seller of the book,
"Becoming a Supple Leopard."
Really, a great book if you're-
- So, is it a hunting book?
(Bob laughs)
No, it's about muscles and tissue and...
- Mobilization and moving right and lifting right.
If you are an athlete,
you definitely want to take a look at it.
If you're just trying to get some mobility back,
you should look at it.
So, this all started in 1978.
So, Gabe Mirkin coined the phrase RICE
for treatment after an injury.
You have rest, ice, compression,
and elevation for soft tissue injuries.
- Right, so the ankle sprain, you do those four things
and it's the way you start out your treatment.
- This is where things
get a little interesting, Brad, though.
In 2000, I can't remember what the date was.
It was the teens, I believe 2000 teens,
he announced rest and ice can actually delay healing.
So, the guy that came up with the phrase
said it can delay healing
and actually cause additional damage.
So, as far as studies, I did see one recently about moving.
Like, you know, rest versus moving after injury,
and they had found that yes, low intensity movement
was a lot better than rest after an injury.
Now, we're not talking about a fracture, of course.
We're talking about a strain,
but getting the muscles moving, I can buy into that.
- I can. You know, obviously if it's a real severe sprain
and it's swelling up like a watermelon and is very tender,
the movement's gonna be pretty subtle at first,
I would imagine.
Even just get the muscles to contract
so we get some fluid movement in the tissue.
- Right. - Yeah.
- So, Gary Reinl, the author
of the book that we were talking about,
you know, when you ask if you should ice something,
he said, "No, it's the worst thing you can do."
So, his argument-
- It's the worst thing you can do.
We've been doing the worst thing for the last 30 years.
It takes me a while to swallow that.
- I know. (Brad laughs)
So, you're trapping waste in and around the damaged site.
I do buy into that.
You prevent the flow of oxygen,
so anything supplied via that blood circulation
is not being supplied
'cause ice does slow it down.
- Well, veins will constrict is what the theory is.
It pushes out fluid- - It might bring it back in.
- Bring it back in, I know that was the theory.
So, now we've got a different theory.
- He said, too, it can cause
additional damage to tissues and nerves.
So, you don't remember this, Brad,
but Chris and I-
- How do you know?
- Because you don't. (Brad laughs)
Chris and I had this discussion
when we were talking about ibuprofen
and I said, "Does that delay healing
because it's delaying the swelling?"
- Oh, right.
- And he said, "Yeah, it could."
So, it's interesting.
- Right, the inflammatory phase of an injury is good.
It's part of what the body is supposed to do to heal
but the theory is it over does itself.
- It overdoes it, right.
Exactly and so that's what ice is supposed to help with
but they're saying, no, it really doesn't overdo it.
You just have to control that swelling in some other way.
So, you know, through wrapping or active motion.
So again, what they recommend is active recovery
or using a muscle stimulator.
Like, on the areas to make the muscles work on their own.
- So like a TENS unit that has EMS.
- Yeah, EMS units.
Electrical muscle stimulation.
- So, I would think water,
you know, if you had a pool or something
where it may be more comfortable
to move the ankle or the knee
but that's not very accessible for certain people.
- Right, well, are you talking about an ice bath?
- No, no, no.
- Just water.
- Like a pool. - Oh, sure.
- You know.
- So, you know, ice does help with pain and swelling,
there's no doubt,
but they're saying the body knows how to heal.
Ice was never around for the early ancestors.
- Well, in the wintertime it was. Snow banks.
- There we go.
Again, we're not arguing one way or the other,
we're just presenting it to you.
You can decide.
I'm sure there'll be more studies that come out.
- But this is really good news
because there are people, I've had patients
they just do not-
- Not like ice. - Like any ice whatsoever.
If it touches them, and it just make them jump.
So, yeah, get it moving, get the part moving.
Don't overdo it. Do it so it-
- Well, it's gotta be pain-free movement.
- Right. - It's gotta be.
- And of course, the compression,
the wraps. - Right.
Compression's still a good idea.
- They're saying that's good.
So, you know, it's not that far out, once we think about it.
It's just a little...
- Yeah, I like the movement idea.
- The compression's good, too.
- All right. - Very good.
- Give us your comments below.
We always love people's opinions, so lay 'em on us.
- That's right. Good luck without icing.
One less thing to do.
- Thanks for watching.
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