Injuries, Icing, and Chinese Medicine

Injured? Keep it moving.

Both ice and rest have been a part of the standard biomedical response to athletic physical injury since Dr. Gabe Mirkin coined the term "R.I.C.E." for Rest Ice Compression and Elevation, in the 1978 text entitled The Sportsmedicine Book. In 2015, Dr. Mirkin reversed his opinion stating,

“When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94). Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” 1

This tracks with the classical Chinese medical theory that pain is caused by obstruction and lack of flow in the channels of the body, understood to be those fluid-filled interstitial spaces that exist in between the capillaries and cells of our bodies. Chinese medical wisdom would say that the cold nature of ice slows the fluids of the body, and makes the tissues more rigid, thus inhibiting the flow of qi and blood to and from an area of injury and impeding the healing process. Not only does this lack of qi and blood flow delay the process of healing, if occurring repeatedly over time this obstruction will lead to weakness.

Chinese medical wisdom would say that the cold nature of ice slows the fluids of the body, and makes the tissues more rigid, thus inhibiting the flow of qi and blood to and from an area of injury and impeding the healing process.

We see this classical way of thinking borne out in modern scientific research that shows while the application of ice to an injured area reduces the sensation of pain through numbing, it slows the movement of fluid through the circulatory system, decreases the flexibility of lymphatic vessels, and ultimately leads to weaker tissue that is more susceptible to repeat injury after the initial damage has occurred. In a study conducted on rats in 2011, the researchers observed that, “Due to icing applied soon after the injury for 20 min, degeneration and inflammatory reaction in the injured muscle were delayed ∼1 day, and not only a delay in muscle regeneration but also impairment, at least in part, of muscle regeneration, and excessive collagen deposition were caused.”2

Likewise, the assertion that immobilization of an injured area facilitates healing runs counter to the same concepts in classical Chinese physiology: movement of qi, blood, and fluids that is free of obstruction is paramount to health and the prevention of disease. Prolonged immobility leads to stagnation of qi, blood, and fluids, and is often associated with pathology in the clinic.

Treating Injuries with Chinese Medicine

In the classical Chinese medical approach, areas of the body suffering from acute physical injury are treated with acupuncture, guasha, cupping, moxa, as well as topical and internal herbal medicine when appropriate. All these modalities are employed with the intention of facilitating movement in the area to clear heat, prevent blood stasis, and prevent prolonged and excessive fluid accumulation in order to prevent the development of chronic injury and pain.

Different levels of severity warrant different types of treatment, and potentially different topical and internal herbal formulas. Keeping the appropriate topical medicine on hand is the best way to deal with non-life-threatening, closed injuries. Examples of topicals I frequently use and recommend in the management of martial arts injuries are Stage 1 Trauma Ointment and Herbal Ice from the Tooth From the Tiger’s Mouth line of products made by Kamwo Meridian Herbs in New York. The main difference between the two is that the Herbal Ice soft plaster is intended for injuries that present with redness, heat, significant swelling, and pain whereas the Trauma Ointment is for injuries with significant bruising, swelling, and pain, without heat or redness. The next time you think to reach for ice after an acute injury, use one of the above mentioned soft-plasters instead without delay.

*If an injury is severe, or if the wound is open and bleeding (something bigger than a Band-Aid can cover), always seek care at your nearest immediate care facility or emergency department.

Injuries past stage 1 of trauma are beyond the scope of this post, but you can assume safely that ice is never appropriate for a subacute or chronic injury.

References

1. Mirkin, G. (2021, May 9). Why Ice Delays Recovery. DrMirkin.com: Dr. Gabe Mirkin on Fitness, Health, and Nutrition. Retrieved July 8, 2022, from https://www.drmirkin.com/fitness/why-ice-delays-recovery.html

2. Takagi, R., Fujita, N., Arakawa, T., Kawada, S., Ishii, N., & Miki, A. (2011). Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats. Journal of Applied Physiology, 110(2), 382–388. https://doi.org/10.1152/japplphysiol.01187.2010