Guest blog by John Davis (RunnersConnect)
Icing: there’s probably no injury treatment that’s more ubiquitous.
At high school cross country meets, you’ll see ice bags and ice cups littered everywhere. At running stores, you’ll find reusable ice packs and specially-designed icing sleeves. And if you ask a doctor what to do about a running injury, the response will almost invariably include “ice it.”
However, as researchers and coaches are starting to learn more about how inflammation works, our understanding of how to treat injuries is changing.
For example, about 18 months ago we published this post on why you shouldn’t use anti-inflammatories (one of the go-to treatments when runners get hurt).
In short, the research shows that some inflammation is a natural and good thing so inhibiting it actually hinders the healing process.
But, what does the research say on icing? Is it the same effect as anti-inflammatories? Is icing useful in every situation? If so, what’s the best way to go about it?
Icing and overuse running injuries
Given the near ubiquitous recommendation to ice when injured, you’d expect there to be reams of studies on such a universal injury treatment. But, astoundingly, there aren’t.
There’s a moderately-sized collection of controlled experiments on using icing (or “cryotherapy” as it’s known in medical circles) for acute injuries, like ankle sprains and post-surgery recovery, but research into icing for overuse injuries, like the ones runners get, is quite limited.
Some papers mention cryotherapy as a treatment for tendon injuries, plantar fasciitis, or shin splints, but it’s only in passing—there’s been essentially no rigorous testing of icing as a treatment for running injuries.
Icing was used as control treatment in a 2007 study on eccentric exercises for Achilles tendonitis; the rehab exercises were vastly more successful than icing. Aside from this, nothing!
Because of the lack of research, we can’t conclusively prove whether or not icing is a useful therapy.
However, this doesn’t mean there’s nothing to take away from the research about icing.
Instead of looking to direct studies on icing for running injuries, we’ll have to learn from research on icing for acute injuries with the understanding that we are operating under the assumption that icing helps with overuse injuries.
Going by the anecdotal experience of many thousands of runners in the real world, this seems to be a safe assumption, but until the science is in, it’s nothing more than that.
Quick icing therapy for ankle sprain
One thing appears certain: quick icing is definitely the proper response to an acute injury like an ankle sprain. (*acute injuries are those that occur suddenly, like when you turn your ankle, while overuse injuries are those that occur due to repeated stress)
A 1982 study of 37 people with ankle sprains investigated the effects of ice and heat on time to recovery. The researchers reported that the patients who heated their injured ankle during the initial days following the sprain took over twice as long to recover as those who iced immediately.
The timing of the icing had a big impact, too—delaying icing for a day and a half similarly resulted in a greater than two-fold increase in recovery time in serious ankle sprains when compared to icing within the first 36 hours following the injury.
Other research suggests that doing “intermittent icing” is more effective than longer continuous blocks of icing. A clever 2006 study by three researchers in the UK split 89 people with ankle sprains into two groups.
The first group was instructed to ice their injured ankle continuously for 20 minutes every two hours over the first three days following the injury. The second group also iced every two hours, but iced for ten minutes, removed the ice for 10 minutes, then iced for another 10 minutes.
This small difference in icing strategy resulted in significantly less pain during activity in the first week following the injury. After this, both groups reported the same levels of pain, which dropped off over the next five weeks.
If icing is beneficial for running injuries, it is likely most beneficial as a front-line treatment used immediately after an injury flares up.
Acute injuries, like ankle sprains, are marked by inflammation—icing is known to help limit localized inflammation by reducing blood flow.
It’s been well-established that overuse injuries like tendonitis are not inflammatory after several weeks, but some researchers believe there is a brief “inflammatory phase” that lasts a few days or a few weeks.
If this exists, this is likely when icing would make a difference.
The usefulness of icing in the treatment of running injuries is unclear—on one hand, since there isn’t a single study supporting the use of cryotherapy in the treatment of overuse injuries.
On the other, there are ice bags and cups in nearly every athletic training room and physical therapy office in the country—ignoring anecdotal evidence of that magnitude isn’t a particularly attractive option either.
What we can say is that if icing is beneficial, it’s going to be most effective if you apply ice immediately after you aggravate an injury, then do not ice again.
Further, it is best to use an intermittent approach: ice for ten minutes, then remove it for 10 minutes, then reapply the ice for another 10 minutes.