Cryotherapy – Ice for Healing Running Injuries

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Icing is a core part of my recovery process and I've consistently found it to dramatically improve muscle healing. Short periods of ice (~20 minutes) will reduce blood flow which may limit further damage due to excessive inflammation. Longer periods (several hours) of icing increases blood flow, which improves healing. It's vital to use ice (frozen water), not a gel pack to prevent skin damage and for effectiveness.

1 Cold Induced Vasodilatation

Cold initially reduces blood flow, but after about 20 minutes the body increases blood flow, possibly to prevent skin damage. This is called Cold Induced Vasodilatation (CIVD) and has been known about since 1930[1][2]). It's important to stay warm overall while icing a muscle, as reduced body temperature prevents CIVD[3][4]. This alternating reduction in inflammation and increased blood flow is believed to act as a 'pump', speeding up heeling. This cycle typically takes a few minutes, as shown below. CIVD.jpg

2 The (Lack) of Science

There is remarkably little science produced on Cold Induced Vasodilation. A 2004 analysis of the available research at the time stated "Currently, no authors have assessed the efficacy of ice in the treatment of muscle contusions or strains. Considering that most injuries are muscle strains and contusions, this is a large void in the literature." A 2008 study stated in its conclusion "There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries"[5]Cite error: Closing </ref> missing for <ref> tag [4] [3] [6] [5] [7] [8] [9] [10] [11] [12] [2] [13] [14] [15] [16] [17] [18] [19] [20] [1]

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  1. ↑ 1.0 1.1 Lewis, Thomas. "Observations upon the reactions of the vessels of the human skin to cold." Heart 15.2 (1930): 177-208.
  2. ↑ 2.0 2.1 C. O'Brien, Reproducibility of the cold-induced vasodilation response in the human finger., J Appl Physiol (1985), volume 98, issue 4, pages 1334-40, Apr 2005, doi 10.1152/japplphysiol.00859.2004, PMID 15579576
  3. ↑ 3.0 3.1 HA. Daanen, Finger cold-induced vasodilation: a review., Eur J Appl Physiol, volume 89, issue 5, pages 411-26, Jun 2003, doi 10.1007/s00421-003-0818-2, PMID 12712346
  4. ↑ 4.0 4.1 HA. Daanen, MB. Ducharme, Finger cold-induced vasodilation during mild hypothermia, hyperthermia and at thermoneutrality., Aviat Space Environ Med, volume 70, issue 12, pages 1206-10, Dec 1999, PMID 10596776
  5. ↑ 5.0 5.1 TJ. Hubbard, CR. Denegar, Does Cryotherapy Improve Outcomes With Soft Tissue Injury?, J Athl Train, volume 39, issue 3, pages 278-279, 9 2004, PMID 15496998
  6. ↑ Ching-Yu Tseng, Jo-Ping Lee, Yung-Shen Tsai, Shin-Da Lee, Chung-Lan Kao, Te-Chih Liu, Cheng-Shou Lai, M. Brennan Harris, Chia-Hua Kuo, Topical Cooling (Icing) Delays Recovery from Eccentric Exercise-Induced Muscle Damage, Journal of Strength and Conditioning Research, 2012, pages 1, ISSN 1064-8011, doi 10.1519/JSC.0b013e318267a22c
  7. ↑ NC. Collins, Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?, Emerg Med J, volume 25, issue 2, pages 65-8, Feb 2008, doi 10.1136/emj.2007.051664, PMID 18212134
  8. ↑ MA. Merrick, LS. Jutte, ME. Smith, Cold Modalities With Different Thermodynamic Properties Produce Different Surface and Intramuscular Temperatures., J Athl Train, volume 38, issue 1, pages 28-33, Mar 2003, PMID 12937469
  9. ↑ JW. Otte, MA. Merrick, CD. Ingersoll, ML. Cordova, Subcutaneous adipose tissue thickness alters cooling time during cryotherapy., Arch Phys Med Rehabil, volume 83, issue 11, pages 1501-5, Nov 2002, PMID 12422316
  10. ↑ author Bryan A. Born, The Essential Massage Companion: Everything You Need to Know to Navigate Safely Through Today's Drugs and Diseases, date 1 January 2005, publisher Concepts Born, llc, isbn 978-0-9749258-0-6, pages 35–
  11. ↑ Putting ice on injuries could slow healing http://www.telegraph.co.uk/health/healthnews/8087777/Putting-ice-on-injuries-could-slow-healing.html
  12. ↑ DA. Alaseirlis, Y. Li, F. Cilli, FH. Fu, JH. Wang, Decreasing inflammatory response of injured patellar tendons results in increased collagen fibril diameters., Connect Tissue Res, volume 46, issue 1, pages 12-7, 2005, doi 10.1080/03008200590935501, PMID 16019409
  13. ↑ Tsang, K. K. W., B. P. Buxton, and W. K. Guion. "The effects of cryotherapy applied through various barriers." Occupational Health and Industrial Medicine 2.38 (1998): 102.
  14. ↑ JE. Zemke, JC. Andersen, WK. Guion, J. McMillan, AB. Joyner, Intramuscular temperature responses in the human leg to two forms of cryotherapy: ice massage and ice bag., J Orthop Sports Phys Ther, volume 27, issue 4, pages 301-7, Apr 1998, doi 10.2519/jospt.1998.27.4.301, PMID 9549714
  15. ↑ MA. Merrick, KL. Knight, CD. Ingersoll, JA. Potteiger, The effects of ice and compression wraps on intramuscular temperatures at various depths., J Athl Train, volume 28, issue 3, pages 236-45, 1993, PMID 16558238
  16. ↑ AA. Gage, What temperature is lethal for cells?, J Dermatol Surg Oncol, volume 5, issue 6, pages 459-60, 464, Jun 1979, PMID 110858
  17. ↑ P. Janwantanakul, The effect of quantity of ice and size of contact area on ice pack/skin interface temperature., Physiotherapy, volume 95, issue 2, pages 120-5, Jun 2009, doi 10.1016/j.physio.2009.01.004, PMID 19627693
  18. ↑ MM. Avram, RS. Harry, Cryolipolysis for subcutaneous fat layer reduction., Lasers Surg Med, volume 41, issue 10, pages 703-8, Dec 2009, doi 10.1002/lsm.20864, PMID 20014262
  19. ↑ AA. Gage, JA. Caruana, M. Montes, Critical temperature for skin necrosis in experimental cryosurgery., Cryobiology, volume 19, issue 3, pages 273-82, Jun 1982, PMID 7105779
  20. ↑ H. Lu, D. Huang, N. Saederup, IF. Charo, RM. Ransohoff, L. Zhou, Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury., FASEB J, volume 25, issue 1, pages 358-69, Jan 2011, doi 10.1096/fj.10-171579, PMID 20889618
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