Recovering from DOMS

Delayed muscle soreness after intense exercise is expected. There are proven ways of reducing these pains quickly to get back into your normal level of training

Your future is created by what you do today, not tomorrow

So we’ve discussed the specific differences of muscle soreness after a workout and soreness from an injury. When you get Delayed Onset Muscle Soreness (DOMS) it is quite annoying trying to continue with training. Knowing that with DOMS we get the following problems.

  • Strength can be reduced by up to 50%
  • Range of movement will be limited
  • Pain will last between 48-72 hours

Understanding these limitations, its important to scale the weight, the depths and distances to accommodate for these temporary draw backs. But there are ways of accelerating the recovery or at least making it more tolerable.

Protein BCAA glutamine1Proteins 

Amino acids are the building blocks of proteins. As muscle damage is the precursor to DOMS, supplying it with a good source of Amino acids has been show to assist in recovery. While having a well balanced diet, additional supplements of glutamine and BCAA’s can reduce the inevitable weakness post workout. It may even help with soreness. (1,2,3,4)

Vitamin D

vitamin-d-en-fb.jpgGetting a little bit of sunshine might not be enough. The latest NZ Ministry of Health stats showed 32% of the population had lower than normal Vit-D levels. There is a link between people low in vitamin D and increased pain sensitivities (5). Taking supplements of Vitamin D3 may help additional soreness.

1023029.jpgHeat

Jumping in the spa pool or a using the hot water bottle. Heat is always soothing but it has longer lasting benefits to use heat with DOMS for the overall recovery (6,7).

Tart Cherry Juice

Tart cherry Juice muscle.jpgThis one is an unusual remedy but the benefits have been shown in this study (8). Following Exercise there was a 22% less weakness from the cherry drinking group, but no effect on pain. There are many natural anti inflammatory agents in cherries that is thought to help.

CoffeeCoffee Muscle soreness

I for one am pleased this is on the list, it gives me more reason to drink it! Studies have shown that caffeine helps lower pain levels and improve weakness during DOMS (9,10). Also helping increase number of reps compared to control groups.

Compression sleeveCompression Garments

Not necessarily for training, but post workout studies show that wearing compression tights or tops can reduce weakness and pain levels (11,12).

backsquat technqueTraining with DOMS

Even following the above strategies you will still have soreness and weakness. Consider this when training. You want to ensure your training for quality not quantity. Studies show training with soreness is acceptable and will temporarily reduce pain levels (13,14).

Myofascial Rolling (Foam Roller/Lacrosse ball)

Using foam rollers and lacrosse balls into tight tissues is a good way of preparing tissue for working through full ranges of movement. Through changes to mechanorecptors and nociceptors. There are studies showing benefit post workout and regular intervals during 48-72hours of DOMS (15,16).

References

  1. Song-Gyu, (2013), Combined effect of branched-chain amino acids and taurine supplementation on delayed onset muscle soreness and muscle damage in high-intensity eccentric exercise. J Int Soc Sports Nutri
  2. Volek et al, (2013), BCAAs reduce muscle soreness (DOMS) J Int Soc Sports Nutr.
  3. Tajari et al, (2010), Assessment of the effect of L-glutamine supplementation on DOMS Brit J Sports Med
  4. Glyn et al, (2012), Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc of Sports Nutri
  5. Plotnikoff et al, (2003), Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc
  6. Mayer et al. (2006), Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehab
  7. Petrofsky et al, (2017), The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Cl J of Sport Med
  8. Connolly et al, (2006), Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damageBr J Sports Med.
  9. Maridakis et al, (2007), Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise. J Pain
  10. Hurley et al, (2013),  The Effect of Caffeine Ingestion on Delayed Onset Muscle Soreness. J Strength Cond Res
  11. Hill et al, (2014), Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Brit J of Sports Med
  12. Armstrong et al (2015), Compression socks and functional recovery following marathon running: a randomized controlled trial. J Strength and Con Res
  13. Zainuddin et al, (2006), Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Appl Physiol Nutr Metab
  14. Trevor et al, (2008), Effects of a 30-min running performed daily after downhill running on recovery of muscle function and running economy. J Sci and Med Sport,
  15. Pearcey et al, (2015), Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Ath Training
  16. MacDonald et al, (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports & Exs

Sleep Deprivation and Exercise

Trying to balance a busy life, the easiest thing to neglect can be sleep. Trying to exercise in this state can produce poor results.

Souiss 2013 & Rae 2017

How many of us burn the candle at both ends? Balancing a busy workload, maintaining a healthy and social lifestyle. What often leads to sleep deprivation.

These two studies demonstrate the impact of sleep deprivation on performance.

Souiss tested his judo athletes with a number of measures including grip strength, anaerobic capacity and isometric test of elbow flexion. Tests were performed at 9am and 4pm after a judo match. There were 3 scenarios, full sleep (7.5hrs), partial sleep early (10pm-2am) and late (3am-6am).

The results showed with a full sleep performance was better in the afternoon. But with both groups with only partial sleep performance dropped in both the morning and afternoon. The partial sleep group woken early performed worse later in the afternoon.

Rae’s study of cyclists, measuring their strength the day after high intensity interval training, one group with full sleep (7.5hrs) and partial sleep (4hrs). They tested 24 hours later, testing peak power output and surveying fatigue and motivation.

These results showed that with sleep deprivation peak performance output reduced compared with normal sleep. Also sleep deprived felt more tired and less motivated to train. This is just from one night of disrupted sleep.

Sitting back and thinking about the relationship of sleep and performance these results seem pretty obvious. Giving your self normal levels of sleep can improve performance and brain function. Try and make sleep more of a priority in the life balance. The choices we make, dictate the lives we live.

 

Souissi et al, (2013) Effects of time-of-day and partial sleep deprivation on short-term maximal performances of judo competitors. J Strength Cond Res.

Rae et al, (2017), One night of partial sleep deprivation impairs recovery from a single exercise training session. Eur J Appl Physiol.

Continue reading “Sleep Deprivation and Exercise”

Knee OA – The importance on strength training

Knee osteoarthritis can cause major disability. This piece of current literature supports that resistance training plays a major role in pain relief.

Bartholdy 2017

Knee osteoarthritis is a condition that gets treated overly careful due to its painful nature and limiting factors functionally.

Osteoarthritis is the gradual wearing down of the joint surfaces (cartilage) over time. Deterioration over time based on may factors, from the type of work and sport, injury history, genetics (collagen type) etc.

Knee Extensors OA

An exacerbation of osteoarthritis, especially in the knee can be debilitating. Reducing strength, restricting movement and limiting mobility. This recent study analysed almost 5000 participants from 45 trials. It found that the best results for reducing pain and disability was through increasing quads strength by over 30%.

This puts resistance training top of the agenda when trying to alleviate pain in an arthritic knee. Grading the exercises appropriately with the guidance of an expert. This study shows good results of strengthening the quads, we should approach it balanced by also working the other connecting muscles.

Original Abstract

OBJECTIVES: To analyse if exercise interventions for patients with knee osteoarthritis (OA) following the American College of Sports Medicine (ACSM) definition of muscle strength training differs from other types of exercise, and to analyse associations between changes in muscle strength, pain, and disability.

METHODS: A systematic search in 5 electronic databases was performed to identify randomised controlled trials comparing exercise interventions with no intervention in knee OA, and reporting changes in muscle strength and in pain or disability assessed as standardised mean differences (SMD) with 95% confidence intervals (95% CI). Interventions were categorised as ACSM interventions or not-ACSM interventions and compared using stratified random effects meta-analysis models. Associations between knee extensor strength gain and changes in pain/disability were assessed using meta-regression analyses.

RESULTS: The 45 eligible trials with 4699 participants and 56 comparisons (22 ACSM interventions) were included in this analysis. A statistically significant difference favoring the ACSM interventions with respect to knee extensor strength was found [SMD difference: 0.448 (95% CI: 0.091-0.805)]. No differences were observed regarding effects on pain and disability. The meta-regressions indicated that increases in knee extensor strength of 30-40% would be necessary for a likely concomitant beneficial effect on pain and disability, respectively.

CONCLUSION: Exercise interventions following the ACSM criteria for strength training provide superior outcomes in knee extensor strength but not in pain or disability. An increase of less than 30% in knee extensor strength is not likely to be clinically beneficial in terms of changes in pain and disability

https://www.ncbi.nlm.nih.gov/m/pubmed/28438380/

Disc Prolapses that Reabsorb

A recent study shown that re-absorption of disc prolapses is higher than previously thought.

Zhong 2017

The Concern and fear that the words “slipped disc” “disc bulge” or “degenerative disc disease” can be worse than the actual symptoms of pain. The image of being broken and not being able to recover. But as previously noted in another blog about MRI scans, a large number of the general public suffer with a disc prolapse without symptoms. They manage to carry out a normal fulfilled life.

This new study of pooled data from the UK and Japan showed a significantly high number of lumbar disc re-absorption. To be precise it was 66.6% (82.94% in the UK I might add!!). All patients received conservative treatment, there was no invasive treatments like surgery or steroid injections.

This goes to show that with patience in your recovery and the right guidance, spinal problems will resolve without being too hasty for surgery.

 

Original Abstract

BACKGROUND: Lumbar disc herniation (LDH), a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. The incidence of this phenomenon, however, remains unknown.

OBJECTIVE: To analyze the incidence of spontaneous resorption after conservative treatment of LDH using computed tomography and magnetic resonance imaging.

STUDY DESIGN: Meta-analysis and systematic review of cohort studies.

SETTING: The work was performed at The Suzhou Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine.

METHODS: We initiated a search for the period from January 1990 to December 2015 using PubMed, Embase, and the Cochrane Library. Two independent reviewers examined the relevant reports. The references from these reports were also searched for additional trials using the criteria established in the PRISMA statement.

RESULTS: Our results represent the pooled results from 11 cohort studies. The overall incidence of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was 62.58% (95% CI 55.71% – 69.46%).

LIMITATIONS: Our study was limited because there were few sources from which to extract data, either in abstracts or published studies. There were no randomized, controlled trials that met our criteria.

CONCLUSIONS: The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials are necessary to study the phenomenon of spontaneous resorption of LDH.

Chiro.jpg

Reference

Zhong et al, (2017) Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician

Sitting Posture – How important is it really?

Sitting posture is something that get’s heavily criticised and over analysed. There could be more to it than simple ergonomics.

Your best posture is your next posture

In the last several years sitting posture has been classed as the “new smoking” or a dangerous position that will ruin your life. There are various arguments for and against sitting from different health experts and research. My opinion on this topic comes from my own clinical experience and taking value from all of the other respective parties.

First of all, sitting is not dangerous. But the longer we sit over a prolonged time is not healthy

Our body is dynamic and multi-functional, one of these functions is sitting. What’s up for debate is length of time and position. Recent studies have documented the following long term health risks from prolonged sitting.

diabetes-infographic

**These studies are predictors for potential health risks, but are also contributed by poor nutrition, sleep deprivation and lack of exercise.

What’s the physical problem with sitting?

In unsupported sitting (i.e. on the floor, perched sitting) we have some activity from core muscles that stabilise the spine. With no activity we would collapse into a heap.

Our central nervous system cleverly adapts to positions we hold most in the day. In supported sitting our body adjusts, slowly loosing flexibility in the thoracic spine, hips and hamstrings. The trunk muscles, “the core” reduce activity in sitting and loose their primary function of support when doing physical activities. Other muscles like the glutes, scapular stabilisers and posterior rotator cuff become short or weakened.

With the lack of support our body naturally falls into the path of least resistance and this is when changes in posture begin to happen. Essentially causing us to hang off the tension of ligaments and other soft tissue, instead of support from the tone and strength of stabilising muscles.

Chemical changes are brewing while sitting

The longer we sit without movement puts more stress and pressure specific tissues. Causing reduced blood flow to that area, meaning it gets less oxygen and less removal of metabolic bi-products. The muscle becomes increasingly toxic and acidic.

Luckily our tissues hold acidic sensing Ion channels that detect changes to PH levels. When in an acidic environment it sends our brain a signal and we get the feeling of discomfort.

Choosing to ignore the discomfort and stay in the same position causes an increase in toxicity and will result in the development of the trigger point phenomenon. Another phenomenon called central sensitisation may also happen. When pain signals constantly bombard the brain with pain signals it lowers your pain thresh-hold, making you more susceptible to pain in stressful environments.

Whats the answer to sitting?

Looking at the physical and chemical changes that happen in a sustained position you can see that any position for a prolonged time is not beneficial to us.

A posture that doesn’t move isn’t a postural problem, it’s a problem of movement.

“Neutral” spinal and postural alignment is all well and said. But even sitting in an ergonomically aligned position will feel uncomfortable if sat this way for 8 hours.

To counteract the negative effects of sustained sitting positions, here are some recommendations:

1. Position variation

Look at the postures below. Some of them were traditionally classed as “bad” postures. But these postures vary the tensions and stress’s applied to different tissue. By regularly changing these forces it will allow you to tolerate sitting for longer. Making a conscious effort to change position every 15-20 minutes (remember you can still work, just change position).

Sitting variation

2. Get up and move

Offload the stress and compression of your toxic butt! Giving a chance for tissue to oxygenate and flush unwanted toxins away. Also reducing eye strain, stress levels and fatigue. Not to mention all the other long term health benefits displayed above.

Studies have shown improvements in performance with intermittent breaks every 30 minutes (4). Consider standing when taking a phone call. Think about how many calls you get a day!

3. Sit-standing desks

Standing desks have taken off and are all the rage in open plan offices. Standing gives those stablising muscles a chance to work their magic. But even with standing you should consider regularly changing standing positions to offload pressures. Using a perching stool or foot stool to alternate step-standing.

4. Exercise

If this component is not included all of the above strategies will be wasted. Standing desks are not an exercise, it encourages a little more activity and is more sustainable. But your body needs to be challenged in other positions other than the one you hold most of the day. The long term health benefits are well documented for exercise.

Remember if you are just starting to exercise and coming from prolonged sitting over a number of years, ease into exercise gradually. Start off with regular power walks or exercycle. But as your fitness improves try to challenge it more, through other sources like pilates, yoga, resistance training or team sports.

Sitting isn’t the problem, it’s not moving enough. 

  1. Bell et al, (2014) Combined effect of physical activity and leisure time sitting on long-term risk of incident obesity and metabolic risk factor clustering. Diabetologia
  2. Schmid et al, (2014) Sedentary behavior increases the risk of certain cancers. J Natl Cancer Inst

  3. Katzmarzyk et al, (2012) Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis. 
  4. Thorp et al (2014), Breaking up workplace sitting time with intermittent standing bouts improves fatigue and musculoskeletal discomfort in overweight/obese office workers. Occup Environ Med.

Coping with stress – Part 2

Trying to change the environment and cause of stress can be challenging. But there are some basic strategies to lighten the level of stress you feel.

It’s not the Load that breaks you down, it’s the way you carry it.

Right, so we understand the main causes of stress, its impact on bodily functions and affect on pain sensitivity when we have an injury. How do we learn to cope with different types of stress? What can I do to make it easier? A “stress free zone” may be impossible but a “stress reduced zone” is better than nothing.

Recognising stress

You might notice your muscles getting tighter when training in the gym. To prevent a strain of the muscle and relieve the tightness, you would stretch or use a foam roller. The same applies to emotional stress. We all respond differently to stress and it sometimes can be the subtle changes that we need to recognise.

Changes like shallow breathing, palpitations, tense muscles, perspiring. If things like this start to happen it’s important to stop for a moment and consider “is this stress benefiting me or another person?”. Remember, stress is a system to save us or someone else from a life threatening situation.

Question your stress – is the feeling beneficial to me or someone else?

Stress is a great response to have, for example if someone was chasing after you with a knife or you needed to save someone from being run over. Consider the stress felt if you’re receiving more emails than normal, having relationship difficulties or have demanding kids. Is this stress response beneficial to anyone?

Managing stress

Look at the following strategies, some may be easier said than done but if it helps alleviate a small amount of stress it’s a start:

  • Take charge of the situation, make changes where possible, including the way you react to it
  • Tune out negative thoughts, adapt to more moderate/positive views
  • Step back from the situation to gain perspective
  • Take regular breaks – diffuse your brain from constant activity
  • Set realistic Goals
  • Keep hydrated, healthy eating and sleeping
  • Find a healthy outsource to down regulate, exercise, deep breathing, meditation

Strategies for dealing with stress

Lung iconBreathing

Focusing on something as simple as breathing is a way to off load demand on our nervous system. Allowing full expansion of the lungs changes the flow of blood through the body and the stretch response on the lung tissue decreases the sympathetic nervous system allowing stress factors to be relieved (1).

Sitting down, place a towel around the ribs and hold it tight at the front. Breath down to the lower ribs to get them to expand. Take in a slow but normal deep breath and exhale at the same speed.

Slsleep-icon-29.jpgeeping

We’ve heard 8 hours of sleep is good for us. How many of you stick to that practice? Sleep deprivation impacts our hormones that regulate stress levels (2) and can have many other health implications (i.e. diabetes, obesity).

Structure your sleep, be consistent with when you go to bed, try not to eat 2 hours before hand, avoid staring at a screen 1 hour before.

*There should be no guilt with napping. Your body clock (circadian clock), follows a rhythm through the day and twice our body temperature drops slightly to prepare us for sleep. Once in the evening and 8-10 hours after we wake up (mid-day slump). Our busy lives during a working week restrict us from napping. But at weekends a siesta can be of benefit (3,4).

Circle-icons-water.svgHydration

Cortisol is a stress regulating hormone in the body and has been found to increase when poorly hydrated (5). Trying to maintain 2 liters of water a day, obviously more if you have been training.

exercise-icon-19Meditation

Giving your self time to step back from your busy life and switch off can be hard. Meditation has been shown to reduce stress and anxiety levels (6). Meditation can come in a number of forms; from formal classes, youtube videos, even to walking or running in the park. The idea remains the same, to switch off your overactive brain.

 exercise-icon-19 (1)Exercise

Exercise comes in all types and it’s been well published to help not only with physical but also mental health (7). Find a way of fitting in some exercise each day whether it be high intensity, a team sport or just getting out for a run.

Many of the suggested strategies are essential to our own existence. But how often do we think about full diaphragmatic breathing, prioritising sleep and hydration? These are suggestions to reduce stress levels, the causes of stress will continue to be demanding if not changed.

  1. Eckberg, D. L. (2003). The human respiratory gate. The J of Physiology
  2. Spiegel (1999) Impact of sleep debt on metabolic and endocrine function. Lancet
  3. Murphy (1997) Night time drop in body temperature: a physiological trigger for sleep onset? Sleep J
  4. Monk et al, (1996) Circadian determinants of the post-lunch dip in performance. Chronobiol Int
  5. Maresh Et al (2006) Effect of hydration state on testosterone and cortisol responses to training-intensity exercise in collegiate runners. Int J Sports Med
  6. Schmidtman et al, (2006) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders The J Neuropsychiatry and Clinical Neurosciences
  7. Anderson et al, (2013) Effects of Exercise and Physical Activity on Anxiety Front Psychiatry

Coping with Stress – Part 1

We all suffer with stress and it’s becoming a growing problem where people struggle to cope and burnout. Stress impacts my patients on a number of levels, mainly with pain perception. When under control we have better recoveries from injury.

The Greatest weapon against stress is our ability to choose one thought over another.

Everyone can recognise stress in their daily life. Some people seem to have more stress than others, or is it simply their reaction to events that creates stress? What is stress? And why is a physio talking about stress?

What is stress?

Fight or flight is stress at its very basic. It’s an important mechanism our brain has to cope and be ready for any perceived threat. This causes many bodily changes to prepare us for action, such as increased neural activity, muscle tone, heart rate, breathing pattern disrupted sleep etc. But stress is also emotional and responds with the same physical response. There are two forms of stress positive and negative. It helps to have a balance of both to make logical decisions.

Positive: It can motivate us into action and achieve our goals.

Negative: Too much causes anxiety and other health issues.

There are many forms of emotional stress. Everyone manages stress differently, making it easier for some people to cope with than others. Below are the leading causes of negative stress.

  • Workplace environment, too many emails, phone calls, long hours
  • Divorce/breakups/relationship difficulties
  • Demands of family/children (sleep patterns, household duties, balancing activities)
  • Car accidents. Being stuck in traffic
  • Theft, burglary, loss of personal property
  • Loss of employment or business
  • Death of a family member or close friend
  • Cash flow problems
  • Poor academic performance/work overload

How can stress impact my injury?

When we’re injured we have the mechanical pain from the damaged structures. But carrying negative stress causes increased sensitivity of our pain receptors and decreases the inhibitory interneurones in the central nervous system that regulate how much pain we feel (1,2). If we find ways to channel our stress better the pains we feel from injury become more tolerable.

  1. Donello et al, (2011) A peripheral adrenoceptor-mediated sympathetic mechanism can transform stress-induced analgesia into hyperalgesia.
  2. Corcoran et al, (2015) The Role of the Brain’s Endocannabinoid System in Pain and Its Modulation by Stress.

Hold the Ice – in RICE

Questioning the reasoning of using ice when injured. A lot of current evidence shows that ice may hinder the recovery of an injury.

Changing brings difference, difference brings progress and if progress was easy to achieve it would not be so hard to accomplish. 

This is always going to be a difficult topic to discuss when dealing with an acute injury. The knee jerk reaction is to apply the ice to the sprained ankle or twisted knee as it’s something commonly used in general practice for over 40 years. This is not me condoning the use of the ice if you’ve had good experiences with it in the past, just providing another way of approaching the recovery of an injury with current literature and using clinic reasoning.

Most of us have been familiar with R.I.C.E. (Rest, Ice, Compression, Elevation) for the initial treatment of acute injuries, which was first published in sports medicine book by Dr Gabe Mirkin in 1978. The acronym was easily remembered and became engrained in all environments with little to no challenge of its overall effectiveness. In the last 7-8 years, there has been more evidence published to question inclusion of ice as an essential tool for an acute injury. In fact, Dr Mirkin has reviewed the current research and done a complete turn on his own recommendation of using ice.

Why use Ice?

The whole idea of icing was to restrict blood flow to the damaged structure, to minimise swelling and bleeding. This was to be applied at regular intervals for the first 2-3 days. It was believed that the swelling restricts range of motion and delays the overall length of recovery. Also, it works as a natural numbing agent to help with pain relief

What’s happening when we get injured?

A multitude of things begin to happen in the body when faced with an injury. You may be aware of the three stages of an injury; acute inflammation, proliferation and remodelling. In that inflammatory stage the blood vessels dilate and increase permeability allowing an increased supply of white blood cells (Microphages and leukocytes) to the damaged site. These blood cells will help break down the damaged tissue and to promote healing will produce growth hormones. There is also increased swelling and the joint becomes more restricted and increases sensitivity to pain which both protects the joint from further damage. Our other less known system in the body, the lymphatic system (the “sewerage” system) slowly helps drain the area of fluid and other by-products.

What is the current evidence showing?

If blood flow is restricted through ice, this limits the release of white blood cells to the area. Lu (1) found that with a steady supply of growth hormone soft tissue can heal at a normal rate compared to tissue with limited/no supply of the hormone. Also, when ice is applied it has a longer lasting effect on vasoconstriction even after the ice has been removed (2), meaning the supply of these white blood cells is depleted for a prolonged time.

Also, the lymphatic system that I mentioned which helps draw away swelling and the “junk”, this is assisted by the pumping action of muscle contractions. Bleakley (3) demonstrated that the strength of a contraction is depleted when iced is applied and this would impact on the pumping action to lymph nodes that help draw swelling away from the injured site. Also, icing the injured site causes changes to the permeability of the lymphatic system causing fluid to leak back into the injured site cause more swelling (4 – I know it’s old but it was a foundational study).

Another study in 2011 (5) broke down the stages of healing even further, the soft tissue was sampled physiologically and under a microscope, comparing damaged tissue that had been iced and non-iced.

Time after injury No Icing Group Icing Group
12 hours Macrophages were found within the necrotic muscle fibers (Macrophage migration to an injured site to phagocytose the necrotic muscle fibers is essential for “clean-up”) Less macrophages were found within the necrotic muscle fibers
Day 3 Regenerating muscle cells present Reduced regenerating muscle cells
Day 4 Normal sized muscle cells produced Smaller sized regenerating muscle cells
Day 14 Normal maturation of the regenerating muscle fibers Maturation of the regenerating was visibly reduced
Day 28 Cross-sectional area of the regenerating muscle was 65% greater than the icing group Collagen fibers were seen only among the bundles of muscle fibers as it is seen in healthy muscles Regenerating muscle fibers was significantly less in the icing group (P < 0.01) Abnormal collagen formation where collagen fibers surrounded each muscle fiber

If no ice then what are we left with?

So now we know ice doesn’t need be put on this pedestal of being an essential tool in recovery post injury. It still has its place for pain modulation, but only for short periods otherwise it will cause prolonged vasoconstriction. Also along the lines of avoiding limiting the inflammatory process, we need to refrain from anti-inflammatories and stick to a mild pain killer (ie Panadol) if struggling with discomfort. If this does not control your pain levels, seek your GP for advice on stronger medication

Following an injury, we fear the worst which is understandable, therefore it’s important to have it assessed by a health care professional to determine the degree of the injury and be receive the best advice, treatment and referrals if needed (i.e. X-ray). To kick start the repair process, begin moving the joint or damaged tissue within a comfortable range as soon as possible at regular intervals through the day. When resting consider having the area elevated above the heart and wear some compression. This will all assist with the lymphatic drainage, putting your body in the best environment and allowing it do the work.

Other options worth considering if you have a high pain tolerance and a keen mobiliser. I’ve seen some good results with regular intervals of using voodoo floss recovering from injury. Although there is no literature to support voodoo bands. But in terms of releasing myofascial tissue which is the main structure the band is impacting on, this can improve lymphatic drainage (6).

There is no harm in using ice, as we’ve been using it for a few decades now, but looking at the latest research and its impact on recovery times, you might want to consider your options before chucking on the bag of peas.

  1. H. Lu et al, (2010) Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. The FASEB Journal
  2. Khoshnevis et al, (2015) Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
  3. Bleakley et al, (2012) Should Athletes Return to Sport After Applying Ice? Sports Med
  4. Meeusen, R. (1986) The use of Cryotherapy in Sports Injuries. Sports Medicine.
  5. Takagi, R, et al, (2011) Influence of Icing on Muscle Regeneration After Crush Injury to Skeletal Muscles in Rats. J of App Phys
  6. Bruno C, (2016) Lympho-Fascia Release and Viscerolymphatic Approach To Fascia,