Let me say right now, I 100% know I am in the right school because one of our guest lecturers for my summer class at Lenoir-Rhyne University was Dr. Aaron Horschig from everyone’s favorite Instagram channel @Squat_University. Dr. Horschig didn’t disappoint with an eye-opening lecture on the use of ice. If you love using ice on the daily, you might want to read this article.
First, I want to show you the questions I had to answer, and of course I will give you the answers. I am also going to add a bit more information I learned. Finally I am going to give you a few of the positive uses of ice, and I will of course defend my stance on some of the benefits of ice. Let’s dive in!
Phases of Muscle Injury
1) What are the four independent phases of muscle injury?
- Degeneration
- Inflammation
- Regeneration
- Fibrosis
Let me explain each of them just a bit to bring you up to speed.
When you are injured, whether we are talking about an open cut or a muscle tear, the body will stop the bleeding by forming clots – leading to muscle damage and eventually necrosis or tissue death. This stage is degeneration.
Next comes inflammation, which is where a lot of the controversy we are about to discuss lies. Acute inflammation that follows muscle damage, whether we are referring to post-workout or muscle injury, is a good thing. This is the way the body heals the damage.
Inflammation is the result of increased blood flow via vessel dilation along with increased vessel permeability. Pain will normally accompany this process due to the increased pressure in the injured site for one thing. Increased blood flow and vessel permeability promote:
- Increased oxygen and nutrients
- Increased phagocytosis
- Removal of toxins and wastes
- Ushering in of muscle building proteins, hormones, and other factors that stimulate and promote muscle regeneration
Inflammation is actually the triggering of regeneration in both the recovery of an injured muscle and a muscle recovering from a hard workout. There are two factors, insulin-like growth factor-1 and transforming growth factor-1, which play major roles in regulation activation, proliferation, differentiation, and fusion to existing muscle fibers of satellite cells. One of the big findings in this study is that ice delayed and/or suppressed the activity of satellite cells and kinases in the mTOR pathway during regeneration. Some other research has shown the same in regards to the recovery from strength training. In summary, icing too often might be killing your gains.
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Fibrosis is the final stage of the regeneration process. This is where fibroblasts produce collagen fibers to stabilize the injury. This process produces dense, collagenous framework called scar tissue. Normally this is a good part of the process with the tissue being remodeled to a functional normal appearance. However in this study it appears ice attenuated the process, leading to more than normal collagen surrounding the site and creating a less functional area.
2) What are the role(s) of macrophages in the injury and recovery process?Based on this study it appears macrophages have multiple roles in the healing process. The one that is most known is of course phagocytosis during the degeneration phase where the macrophages aid in the ingestion of bacteria and other harmful debris.
This study demonstrates macrophages migrate from the muscle degeneration phase to the regeneration phase producing TGF-beta 1 and IGF-1.
3) How do TGF-beta 1 and IGF-1 fit into the recovery process from injury and how does ice affect their role? TGF-beta 1 regulates proliferation and differentiation of satellite cells. TGF-beta 1 also stimulates collagen synthesis. IGF-1 stimulates the differentiation and growth of regenerating muscle cells by increasing the size of myotubes and protein synthesis.
This study suggests “icing might retard the proliferation and differentiation of satellite cells and maturation of the regenerating muscle fibers through the retardation of chronological changes in TGF-B1 and IGF1 expressions essential for muscle regeneration.”
4) How can the use of ice (or lack thereof) change the amount and thickness of collagen deposited around the regenerated muscle fibers?With the non-icing group, collagen fibers were only seen among the bundles of muscle fibers. In contrast – in the icing group, the collagen fibers surrounded each of the muscle fibers. Some collagen is a healthy and stabilizing part of the healing process. Excessive collagen will leave the new tissue less functional.
When Not to Ice
So let’s break all of this down into layman’s terms. I did a little research on my own after reading the study and listening to Dr. Horschig’s lecture, and here’s what it comes down to:
- If you are looking to produce the most hypertrophy and strength gains possible, you probably shouldn’t ice after working out. Instead active recovery seems to work better in alleviating muscle soreness. Instead of decreasing inflammation, active recovery encourages more blood flow to the area, increasing the speed of eliminating waste products while flooding the area with nutrients, hormones, and oxygen to aid in the rebuilding process.
- I definitely wouldn’t ice an injury like a muscle sprain, cut, or tear. Instead I would stop the bleeding with pressure, elevate, and use electrical stimulation from a Marc Pro to flush new blood in and old blood out. The Marc Pro will alleviate pain by alleviating the pressure from pooling blood. I used a Marc Pro for the first time after I had a hip replacement. Thank God Kelley Starrett sent me one because it allowed me to have my first good night’s sleep. Now I use it all the time for recovery to encourage healthy blood flow.
So am I saying to burn your ice tubs? Now hold on, let’s not throw out the baby with the bath water.
The Good Side of Ice
The first thing I did when I finished this assignment was to email my buddy Dr. Andy Galpin. I sent him the research article we had read as a class. He agreed in the above conclusions: no ice for hypertrophy and no ice for injuries. However there are other uses for ice that Dr. Galpin loves.
1. Immune System BoosterOur bodies have cold shock proteins and hot shock proteins. Both are lost if you are never exposed to extreme conditions. Both are important to rendering your body resistant to disease. Therefore a contrast cold tub with hot tub is fairly impactful boost to the immune system. As athletes, if we stay healthy it means we can train longer without any setbacks. Whoever trains the longest with optimal training sessions is ultimately the winner.
2. Eliminate Anxiety and Depression While Improving Hormonal BalanceSome studies have shown contrast baths increase dopamine and norepinephrine production, which help keep athletes balanced emotionally. All athletes understand emotional balance is one of the biggest challenges in training and performance.
As a coach of several world-class athletes, I can tell you with 100% confidence the biggest difference between good and great is mindset. Some athletes have control of their emotions, and some are controlled by their emotions. I recommend taking a comprehensive approach toward reducing stress and encouraging mental health.
3. Cardiovascular HealthThere are several studies out there now which show thermic stress producing positive cardiovascular benefits. I am curious if ongoing contrast baths might improve one’s heart rate variability. Here’s one of those studies.
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4. Recovery DayIf you are going through a high volume period, there is nothing wrong with fitting in a contrast day. I recommend performing this contrast session during a recovery day to prevent interrupting the hypertrophy process post-workout. There is some solid evidence showing significant effects on power and neuromuscular function. Therefore if you are a weightlifter or power athlete in some other sport like throwing, long jumping, or something similar, cold-water immersion with a contrasted heat bath makes total sense.
However based on the lecture by Dr. Horschig, I recommend pairing your recovery contrast session with some light active recovery. Specifically, I recommend some sled drags, sled walk and press, and/or sled walk and rows paired with some light movement work designed to target problematic joints or joints that seem to be overstressed. There is a pile of evidence suggesting active recovery to be superior to cold water immersion for recovery. Therefore pairing active recovery with some contrast techniques is the way I recommend going in order to help the neuromuscular system bounce back from high volume training.
Here’s what I prescribe to my athletes:
- Sled drags, sled walk and press, and/or sled walk and row – which one depends on whether you have worked your upper, lower, or total body. Spending 15-20 minutes dragging the sled 60 seconds with 60 seconds rest is a great start to active recovery day.
- Three to five sets of ten repetitions on bodyweight-only movements like air squats, walking lunges, pushups, or some light dumbbell rows
- Crush what hurts. Kelly Starrett is pretty funny with his explanations regarding recovery work. However, it works. I recommend using lacrosse balls or body tempering tools to break up tense or overstressed tissue. Does it break up fascia or simply desensitize the area? I don’t really know, but either way I am able to move more functionally afterward.
- Movement targeting troubled joints. For me that is my hips. I like to use jump stretch bands for joint distraction. However, this is a great place to fit in yoga or MobilityWod (my preference).
- Finish this up with 10-20 minutes of contrast therapy (cold water immersion followed by hot tub soak, or vice versa).
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5. Chill Out at the End of the DayIf you want to use cold water immersion contrasted with heat therapy as a way to reset the autonomic nervous system before sleep, I recommend dialing back on the cold and the heat. Too much of either might very well stress your system out. This could very well send you into a sympathetic state, which isn’t good for recovery or sleep. Dr. Galpin recommends dialing back the cold to a simple cool bath and dial the heat back to a warm soak, and this will more than likely improve your quality and duration of sleep.
To Sum It Up
If you are trying heal up post-workout in order to maximize hypertrophy, I recommend staying away from cold water immersion or ice baths. If you are trying to heal a muscular injury, I definitely recommend staying away from ice baths or any other cold therapy. However, I agree with Dr. Andy Galpin that there are other uses for contrast baths and/or cold therapy, which is supported by the current evidence. I wouldn’t use contrast therapy every day, but once or twice per week is a solid idea – especially on recovery day. Active recovery is better for ongoing recovery between hard sessions. Active recovery paired with contrast therapy is a great recovery tool if used sparingly.
Once again, I want to thank Dr. Aaron Horschig for agreeing to guest lecture for our M.S. Exercise Science class at Lenoir-Rhyne University. What other graduate program has rock stars like Dr. Horschig (aka Squat University) taking time out of their day to lecture to a class of grad students? To let you know just how small this strength world really is, my professor and advisor, Dr. Alex Koch, taught Dr. Horschig at the University of Kansas, and Dr. Koch coached Dr. Horschig in the sport of Olympic Weightlifting. It’s crazy to think my professor created the now famous Squat University by building his interest in the sport of weightlifting.
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If you are interested in the Exercise Science Program and/or the Olympic Weightlifting Team at Lenoir-Rhyne University, email me at Travis.Mash@LR.edu
References stated very simply:1. “Influence of icing on muscle regeneration after crush injury to skeletalmuscles in rats”Ryo Takagi,1Naoto Fujita,1Takamitsu Arakawa,1Shigeo Kawada,2Naokata Ishii,2and Akinori Miki11Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Kobe; and2Department of LifeScience, Graduate School of Arts and Science, The University of Tokyo, Tokyo, JapanSubmitted 8 October 2010; accepted in final form 13 December 2010https://journals.physiology.org/doi/pdf/10.1152/japplphysiol.01187.20102. “Getting to the Heat (and the Cold) of the Matter: Contrast Therapy 101”https://www.xptlife.com/getting-to-the-heat-and-the-cold-of-the-matter-contrast-therapy-101-part-1 (recommended by Dr. Andy Galpin, simply written but supported with research)
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Maybe I do not understand the article or maybe I am a dinosaur, but for tendon, ligament issues having to do wither with running or bruises or ankle twists, have found ice contrast therapy immediately applied if possible to be phenomenal. 10 mins ice light rub over area with 5 min rest 3 x. Better yet follow with acupuncture needles if possible. Don’t have electrostim so this all seems to help a quick recovery…although electrostim is fabulous especially with needles.
Decades ago, I made ample use of ice jet whirlpools. I also used cold/hot contrasts to stimulate blood pump and flush.
I have since revised my practice for injured athletes to ice for a day, followed by a regular routine of heat. I use the ice to control swelling and pain, then turn to heat to use the lymphatic system to flush “crap” out of the injured area. Last football season, a player who suffered a nasty ankle sprain ices for a day, then did hot laser treatment with our local vet, who was the dad of another player. By Wednesday, he was showing remarkable improvement. He practiced Friday and played the next day, With another player who suffered a nasty hamstring strain (that popping sensation where you feel like you’ve been kicked), I used ice for a day to control pain and swelling, then had him use heat. I encouraged him to move as much as the injury would allow. Fortunately, the muscle hadn’t torn away from tendons or bones. He was 100% in 4 weeks, when a GP had said he was done for 8 weeks. Moral of the story? I still like to use ice for a day as swelling and pain relief, but then get right into heat.
I have been practicing interventional pain medicine and I have five board certifications in interventional pain medicine over the past 30 years of my practice. I only mention this to lend some credence to my comments. Yes plus the fact that I am a national/international level Powerlifter competitor as well. There remains a absolutely final technique that is often not discussed in these circles which addresses the vast majority of the correct scientific and physiologic functions of injury that you noted in your article. That is the use of fractionated platelet rich plasma injection therapy. I have been trying to spread the word about this particular therapy for the athlete whether weekend warrior or international/professional level athlete. It is a technique that is minimal invasive and not only vastly improved recovery times but instead of producing in efficient collagen repair tissue, the various angiogenesis and other repair techniques which you refer to in your article are not only more physiologic but are more productive of a stronger and healthier recovery versus ice, heat, light exercise etc. I agree about the active rehabilitation component, but the addition of PRP for the advanced athlete or even weekend athlete is something that should be discussed and considered more often.