I meant to post this yesterday, but never got a chance to. My colleague Nancy Haggerty had a massive feature on whether or not icing an injury actually hurts more than it helps, run 1A in Tuesday’s Journal News. This would be worth sharing anyway, but since Somers’ Caite Opfer is featured in the article, all the more reason. If you didn’t read it already, here it is:
By Nancy Haggerty
After Somers forward Caite Opfer crashed to the basketball floor in the second quarter with a Mahopac player on top of her Tuesday, she grabbed her left knee and subsequently hobbled off.
She sat for the rest of the first half, a bag of ice on her knee.
Opfer eventually returned, hit a clutch basket and grabbed an offensive rebound, effectively sealing Somers’ win.
The magic was in the ice. Or was it?
Debate is stirring about whether ice — for decades a medicinal tool employed by physicians, athletic trainers and soccer moms alike — is effective in limiting swelling and enabling athletes to return to action.
There are distinct points of view, with few in the middle.
A new book by Gary Reinl, a former personal trainer whose company has developed an electronic stimulation device, argues that ice delays healing.
“It’s clear there’s no evidence — absolutely none — that it helps. There’s indisputable evidence it hurts,” said Reinl, a Nevada resident who has authored “Iced! The Illusionary Treatment Option.”
The book cites studies questioning or assailing the use of ice to treat an injury. In 2008, for instance, the Journal of Emergency Medicine said, “There is insufficient evidence to suggest that cryotherapy (icing) improves clinical outcome.” And last year, the National Strength and Conditioning Association asserted, “Topical cooling (icing) delays recovery.”
Dr. Gabe Mirkin, who is credited with developing the rehabilitation acronym RICE (rest, ice, compression and elevation), said he now supports muscle activation. “Icing decreases circulation, so it slows healing,” he said.
John Shaeffer, an athletic trainer whose well-known athletes include retired Olympic gold-medal short-track speedskater Apolo Ohno and current Olympic snowboarder Louie Vito, stopped icing long ago, finding that compression and lymphatic stimulation returned his athletes to competition 50 percent to 75 percent faster.
“In my opinion, there’s no useful therapeutic use of ice in sports medicine,” Schaeffer said.
Yorktown High School athletic trainer Dave Byrnes, president of Section 1’s Athletic Trainers Society, said the research isn’t definitive. But he also has seen athletes improve faster without ice, and his usage of it is down 50 percent from 10 years ago.
“I’m still guilty of icing acute injuries — acute ankle sprains, where there is golf-ball-size swelling. I do this for 10 minutes,” he said, explaining he couples it with compression as a means of reducing the pain and swelling.
Reinl argues that icing delays inflammation and getting repair hormones to injured areas quickly is essential.
Arizona Diamondbacks head trainer Ken Crenshaw uses ice mostly for pain management, as well as spasm reduction, although he will use ice on baseball players upon request, perceiving a “psychological benefit.” While not seeing a “big negative” to ice, Crenshaw termed a cold lymph system less efficient at removing inflammation.
No one seems opposed to the muscle activation he champions to alleviate swelling. But many involved in athletes’ health still like ice.
“I’m a big believer that all these things can work and play a role,” said Dr. James Gladstone, orthopedic surgeon and co-chief of sports medicine at the Icahn School of Medicine at Mount Sinai Hospital.
Gladstone, who recently served as the U.S. Davis Cup tennis team’s doctor, said ice slows acute-injury bleeding and relieves post-activity soreness.
Inflammation initiates a “healing response.” But swelling’s almost “over-compensation,” said Gladstone, who doesn’t believe that ice delays healing.
North Rockland High School athletic trainer Carol Guzinski, a marathon runner, uses ice on students and herself, employing everything from non-chemical ice packs to ice massage to ice baths.
“I’m happy with the results I see,” Gruzinski said.
“Ice is definitely what you need to do at the very beginning of an injury,” Pace University athletic trainer Barry Moriarty said. “You’re actually preserving part of the tissue. It slows (bleeding).”
Iona College head athletic trainer Sam DeRosa said, “The proof is in the pudding. The swelling is reduced. … It helps localize swelling, enabling the body to handle it better and clear it better.”
Former longtime Yankees trainer Gene Monahan (pictured below, with Derek Jeter), who is now with Hendrick Motorsports, uses ice on new injuries, new stiffness, soreness, swelling and soft-tissue irritation. He would ice pitchers’ arms but not immediately after play, saying in part that icing a warm elbow can lead to nerve irritation and, eventually, arthritis.
Philadelphia Flyers athletic trainer Jim McCrossin also likes ice for preventing acute-injury swelling.
“Gary stating (ice) impedes repair — it could. But my belief is you’ve first got to stop the edema,” McCrossin said, explaining that untreated bleeding often lasts at least a couple of hours.
While Reinl opposes icing for pain relief, contending that pain distinguishes bad from good movement, Aimee Brunelle, president-elect of the New York State Athletic Trainers Association, said numbing allows athletic trainers to move injured areas to facilitate healing.
“You can find studies either way. You can find what you want to read,” said Brunelle, who works at Jamestown Community College.
Reinl believes his research will tip the scale, proclaiming, “The ice age is over.”
That, though, remains to be seen.
“Some things that are 50 years old still make sense,” McCrossin said. “We’re getting people better quicker, and that’s what it’s all about.”
Photo credit: Jim McIsaac/Getty Images