
An article in the Washington Post. Owned by Jeff Bezos, the world's richest man, so it must be true. FULL DISCLOSURE: I frequently ice my knee; it helps. Worth hitting the link for the whole article.
"Why icing a sprain doesn’t help, and could slow recovery"
If you’ve ever needed to recover from an athletic injury, you’ve probably used ice to reduce soreness and swelling. For decades, doctors and athletic trainers have recommended RICE — rest, ice, compression and elevation — to reduce the pain and inflammation of sprained ankles. Inflammation has been viewed as the enemy of recovery.
But what if that’s not quite right? What if inflammation is an indication of recovery, and icing and other cold-based “cryotherapy” only delays it?
Icing, it turns out, is like flossing: an ingrained practice that seems practical but is not strongly supported by clinical evidence. The oldest justifications for icing, dating to the 1970s, have melted under scientific scrutiny, some cryotherapy researchers say, and most scientific studies on icing haven’t provided the solid results that would justify its popularity. This is true, they say, both for icing for daily recovery and for an injury.
For example, a 2008 meta-analysis published in the Journal of Emergency Medicine, which looked at multiple studies on cold therapy’s effect on acute soft tissue injuries, concluded there is “insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.” Similarly, a 2012 paper published in the Journal of Athletic Training, which reviewed multiple, peer-reviewed studies, noted that the practice of using ice to treat sprained ankles “is based largely on anecdotal evidence” and that “evidence from [randomized controlled trials] to support the use of ice in the treatment of acute ankle sprains is limited.”
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Even the doctor who coined RICE no longer promotes it. “It’s perfectly fine to ice if you want, but realize it’s delaying healing,” Gabe Mirkin said, “[Icing] is not going to change anything in the long term.”
Instead of icing to reduce inflammation, athletes might be better off letting it run its course. Better yet, get moving again, Mirkin said: “Don’t increase your pain, but you want to move as soon as you can.”
Athlete and journalist Christie Aschwanden feels a bit vindicated by the research. Despite her experience as a champion cyclist and professional cross-country skier, the use of ice, whether to recover from a hard workout or a rolled ankle, has never appealed to her.
“I used to have a teammate who was really, really devoted to ice baths,” Aschwanden said. “She would fill our hotel bathtub with ice and then go sit in it. I tried it a couple times, but it was really painful. The discomfort and unpleasantness of it canceled out whatever benefits there were.” Now, she said, after researching the issue, “I know there probably weren’t any benefits.”
After further ruminations, on why it's bad the author then backs off and hedges a bit -
This isn’t to say cryotherapy has no physiological effect. Icing to numb something definitely works, and “icing is the safest pain medicine we have,” Mirkin said. Ice may also help people get a damaged area moving again. “If you have an injury, the muscles around it switch off,” limiting mobility, said Chris Bleakley, a professor of physical therapy at High Point University in North Carolina who has studied icing. “Ice helps to switch those muscles back on again.”
Some experts and research organizations who acknowledge the lack of high-quality data in support of ice nevertheless maintain that it’s an important tool for athletes. The National Athletic Trainers’ Association and the National Institutes of Health both recommend icing for sports injuries.
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In the book, Aschwanden describes an encounter with a friend (an icer) who inquired about its effectiveness. “What would you say if I told you it didn’t help?” Aschwanden replied.
“I wouldn’t believe you,” the friend said.
“She wasn’t dismissing me, like I’m not credible source on this,” Aschwanden said. “She was just like, ‘I know it works for me.’ I think for a lot of this stuff, it really comes down to that. People have their personal experiences and those can be very convincing.”

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