Should you ice it?


At one time in your life it’s likely that you’ve had an injury, such as an ankle sprain or hamstring strain. It’s also likely that you applied ice to the damaged tissues, probably because your physician or physical therapist told you to do so.

Was icing that sprained ankle a good idea? It depends.

Let’s start by covering the intended goals of icing. There are four of them:

  • Limit edema formation via vasoconstriction, which reduces the metabolic and vasoactive agents that contribute to inflammation..
  • Reduce pain via decreased nerve conduction velocity.
  • Facilitate muscle relaxation via decreased neural activity.
  • Limit secondary hypoxic tissue injury via decreased metabolic and oxygen demand of living tissues.

Applying ice to an injury will reduce inflammation. That sounds like a good thing, but it might not be.

You see, inflammation is a natural part of the healing process. After an injury, the inflammation process kicks into gear and releases macrophages, which are a type of white blood cells that eat up cellular debris at the site of injury (macrophages literally means “big eaters”). When you ice a body part, vasoconstriction of the blood vessels decreases the amount of macrophages that can arrive at the scene of damage.

The other benefit of macrophages comes from the release of insulin-like growth factor 1 (IGF-1) at the site of damage to promote tissue healing. Therefore, it appears that icing can slow the healing process, and that’s obviously something you don’t want.

However, research demonstrates two possible benefits ice can provide after an injury.

First, it reduces pain. That’s important because pain can change your brain for the worse – specifically, at the somatosensory cortex. Suffering through high levels of pain, when it’s not necessary, will increase the time it takes for you to clear it from your mind.

Second, icing can promote muscle relaxation by decreasing neural activity to the cooled area. This can be beneficial when muscles are overridden with protective tension and filled with painful trigger points. However, this also means that icing can reduce your strength and power. So don’t ice your quads before a heavy set of squats.

So back to that ankle sprain you iced after trying to impress the skaters at the park. If your goal of icing was to expedite healing, it probably wasn’t a good strategy. But if your goal was to reduce pain and promote tissue relaxation, well done!

If you choose to ice an injury, how long should it be applied? There are five stages of sensation when you apply ice to the skin, and they occur in this order:

  • Cold
  • Stinging
  • Burning
  • Aching
  • Numbness

Once you feel numbness in the area, stop icing because the possible benefits it can provide are maxed out at that point. Furthermore, icing beyond the point of numbness increases the risk of tissue damage. This is one of the reasons why icing an area with impaired circulation or damaged nerves is a bad idea.

Even though rest, ice, compression and elevation (RICE) has been viewed as the gold standard recovery protocol for decades, there’s always room for progress. Indeed, Gabe Mirkin MD, the sports medicine doctor that created the RICE acronym back in 1978, has distanced himself from it. Dr. Mirkin now recommends moving sooner rather than later (after it’s confirmed there are no broken bones), applying ice only to reduce pain within the first 6 hours after injury, and compression/elevation if there’s swelling.

In summary, whether or not you ice after an injury depends on your goal. If you’re trying to reduce pain and calm trigger points, stick with it. But if it’s been more than 6 hours since your injury, keep in mind that icing will reduce inflammation to that area, which can slow recovery.

Finally, this discussion about icing an injured body part shouldn’t be confused with cryotherapy in general. There’s some evidence that entering a cryogenic chamber for a few minutes, thus exposing the entire body to a frigid temperature, might promote recovery and potentially provide some health benefits. We’ll have to wait and see how that pans out.

Stay Focused,

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What You Should Know About Sleep

blog sleep Sleep. Very few of us get enough of it, because of stressors with work, family, or in my case, school. Indeed, two years ago I went back to school to get a Doctor of Physical Therapy (DPT) degree. Since that time I’ve unwillingly been a test subject in my own perverse sleep deprivation study.

But I’m going to follow Beyonce’s lead and make some “lemonade” by sharing some facts with you about sleep. We’ll start with the most logical question…

Why do you need sleep?
For eons, scientists have known that sleep is restorative and essential for memory formation. That’s why we need it. But until recently, they weren’t really sure how sleep is restorative. In 2013, a landmark study in the revered Science journal helped explain what’s going on.

While you’re awake, little pieces of protein called beta-amyloid clump together and form plaques. These beta-amyloid plaques are found in the small spaces between the brain’s nerve cells. But if these plaques hang around those small spaces for too long, they can wreak havoc by blocking signals and triggering inflammation in the brain.

In fact, an accumulation of beta-amyloid plaques is closely linked with Alzheimer’s Disease. Yep, that’s how bad those suckers are.

Now, back to the study. The researchers found that sleep opens up small areas of the brain that allows cerebral spinal fluid (CSF) to rush in and clear out the beta-amyloid plaques that accumulated during the day (Xie et al, Science, 2013). Think of CSF as being your brain’s housekeeper.

Sleep’s other function – the formation of memories – is also really important. But I’m not just talking here about learning how to remember calculus formulas or a list of random facts for History class, I’m also talking about memories related to movement. Motor learning, in other words.

When you’re training to improve your technique in, say, an Olympic lift, the brain must increase the strength of its synapses related to that exercise in order to learn how to do it better. How does the brain increase its synaptic strength? While you sleep, it rehearses that Olympic lift.

Let’s say you practiced the snatch lift yesterday afternoon. When you were sleeping last night, your brain activated the same neurons necessary for that movement to occur. It was literally rehearsing what you did so those synapses could get stronger – that’s how motor learning occurs.

However, this mental movement retraining only happens during the rapid eye movement (REM) sleep cycle. There are four stages of sleep that range from drowsiness (stage I) to deep sleep (stage IV). It takes about an hour to get through all four stages. REM is a separate aspect of sleep and it occurs 4-5 times during a normal night of sleep. Each phase of REM sleep gets progressively longer, from 10 minutes early in the night to 50 minutes before waking up.

During REM, your brain releases the neurotransmitter, glycine, which blocks the normal connection you have between your brain and muscles while awake. This glycine release, in essence, makes your body paralyzed, which allows your brain to rehearse the snatch lift without any actual movement taking place. This is akin to a pilot learning how to fly on a flight simulator.

Pretty cool, eh?

How much sleep do you need?
According to research, most people get around 7.5 hours of sleep each night. That falls within the 7-9 hour range recommended for adults (18-64 years) by the National Sleep Foundation.

But if you get 7.5 hours of sleep every night, I can say two things. First, I’m jealous. Second, you’re not like the vast majority of people I know. Indeed, I believe that sleep deprivation is a more widespread problem than some research indicates.

If you sleep any less than 7 hours your risk of weight gain, heart disease and diminished brain function significantly increases. Surprisingly, these same risks are associated with getting more than the recommended 9 hours each night. However, I’m willing to bet that the people who consistently get 10 or more hours of sleep per night are unhealthy because of other reasons related to laziness and poor nutrition.

blog overweight person sleeping

For me, one night of 10 continuous hours of sleep makes my brain sharper and my body stronger. So I’ll take it whenever I can – maybe after I graduate?

If you can’t get 7 hours of sleep at night, make a point to squeeze in a nap during the day. It’s best to get 60-90 min if possible (Mednick et al, Nat Neurosci, 2003), but a nap as short as 6 minutes has been shown to be beneficial and can improve brain function (Lahl et al, J Sleep Res, 2008). There’s no better recovery aid than a nap after you train.

Stay Focused,

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