Well Being: Melting that old advice about ice

Gary Reinl (right), author of "ICED!", with Rich Froning, CrossFit champion. Icing injuries, Reinl says, "delays healing, it increases swelling, causes additional damage."
Gary Reinl (right), author of "ICED!", with Rich Froning, CrossFit champion. Icing injuries, Reinl says, "delays healing, it increases swelling, causes additional damage."
Posted: July 28, 2014

For decades, the standard method for treating injuries was RICE - Rest, Ice, Compression, and Elevation.

Everyone from Little League coaches to pro sports trainers knows icing is a sure way to reduce swelling, inflammation and pain, and speed healing. That has been the conventional wisdom.

Now comes Gary Reinl, with 40 years of experience in sports, fitness, and rehab, with an iconoclastic message. In his self-published book ICED!, Reinl argues that icing is not only wrong - "an illusionary treatment" - but also counterproductive and harmful.

"There's not a shred of evidence that icing is helpful," Reinl said. "To the contrary, it does the opposite. It delays healing, it increases swelling, causes additional damage, and shuts off signals that alert the body to harmful movement."

And yet, Reinl laments, "everyone does it."

Why?

"Because a myth is hard to undo."

Reinl, 61, lives in Henderson, Nev., a suburb of Las Vegas. He grew up in Aldan, Delaware County, and is a proud original member of "Pat Croce's posse." In 1973, he opened the seventh Nautilus gym in the world, he says, where he worked with pro athletes such as Franco Harris. He was also an early advocate of strength training for pregnant women. Later, as general manager of the medical division of Nautilus, he developed a widely adopted strength-training protocol for the elderly. Hired by the company that became Novacare, he steered the nursing-home division into "sports medicine for 95-year-olds."

Determined to resume working with professionals, Reinl began conferring with trainers and rehab coordinators of more than 80 teams, including the Eagles, Flyers, Sixers, and Phillies. Reinl learned nearly all of them used ice for treating damaged tissue. Curious about how ice works and how best to use it, he began doing research.

He read hundreds of scientific papers. What he discovered surprised him: According to the literature, icing doesn't work. Five worldwide reviews have concluded icing not only doesn't promote healing but actually delays it.

"I was one of the few people who knows ice doesn't work, and why," Reinl recalls.

So he began spreading the word. Many experts were skeptical and dismissed Reinl as a wacky heretic. One who was persuaded was Kelly Starrett, a doctor of physical therapy, whom Reinl calls an "international poster boy for the CrossFit movement." With Starrett, Reinl made a video debunking the efficacy of ice that has gone viral on YouTube. Another influential coach Reinl convinced was John Schaeffer of Reading, who has trained such prominent athletes as short-track skater Apolo Ohno and Eagles running back LeSean McCoy.

Perhaps the most significant convert has been Gabe Mirkin, a widely respected physician who coined the acronym RICE in his best-selling The Sports Medicine Book from 1978. After talking to Reinl, Mirkin posted a recantation on his website this year, citing several studies. "Coaches have used my RICE guideline for decades," Mirkin wrote, "but now it appears that both ice and complete rest may delay healing, instead of helping."

Says Reinl: "If the godfather of the Ice Age says don't do it, that's a pretty big deal."

Reinl's case against ice goes like this: Not only is inflammation not bad, it's good. It's the way the body heals. Swelling means the body is bringing healing fluids to the injured area. As Reinl puts it: "The blood vessels surrounding the injury dilate and increase perfusion." Icing, by contrast, causes blood vessels to constrict.

Freezing injured cells kills them, leading to further damage and inflammation. Though ice may temporarily delay swelling, it resumes when the injured area warms up again. It is presumptuous folly to try to reduce swelling, Reinl contends, because the body will dispatch as much fluid to the injured site as it deems necessary.

The way to reduce swelling is to remove the waste at the end of the inflammatory cycle by activating the muscles around the damaged tissue. Sustained swelling occurs not because there's too much fluid but because there's too little evacuation of waste, which is removed by the lymphatic system, which depends on muscle activation.

So instead of RICE, Reinl has formulated a new acronym: ARITA - Active Recovery Is The Answer.


"Well Being" appears every other week, alternating with Sandy Bauers' "GreenSpace" column. Contact Art Carey at art.carey@gmail.com. Read his recent columns at www.philly.com/wellbeing.

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