Community Video – Peoples, We’ve Got to Stop Icing. A Year Later….

    07/29/2013 | 72 Comments

      Hey MWOD Legion,

      In history of the 700+ videos we have created, there is only one video on which I had to turn off YouTube comments. In the same 700 videos, there is only one that has generated more questions and more positive real-world clinical experience. You may already know this video – shot 1 year ago at the CrossFit Games – it’s called People We’ve Got To Stop Icing. We were wrong. So wrong.. I often tell my daughters that Starretts do the right thing and do the hard thing. This video was both – for the dogma it challenged and controversy it generated.

      It is now a year later and, in hindsight, I see that I could have crafted a more elegant argument with a less polarizing title. However, after a year of serious discussion, experimentation and implementation with physicians, trainers, and athletes across dozens of sport platforms – including several hundred pro teams – along with a comprehensive review of the research on this subject, we are still confident that icing is not the best option for facilitating injury recovery or athletic adaptation.

      On the one year anniversary of this viral video, we thought it fitting to sit down again to talk about the impact of the video on our lives and capture some of the specifics we didn’t discuss last year and that we have learned this year.

      As a continued disclaimer for the internet trolls, MobilityWOD has not and does not make any money from MarcPro sales. Instead, MarcPro created a special KSTAR code and, for every 4 units sold using this code, 1 unit is donated active service military members for rehab/recovery purposes.

      - KStar

    • Injury
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72 thoughts on “Community Video – Peoples, We’ve Got to Stop Icing. A Year Later….

  1. Pingback: Kelly Starrett on Icing - All Things Gym

  2. Todd Walter

    I’d really like to see how to get the congestion out of certain areas. I’m in the coast guard and am dealing with shoulder pain for a few months now. How would I get the congestion out of that area?

    Reply
  3. Sam Vernon

    Thanks for the follow up KStar. Love your work. Why are so many athletes at the games using ice baths? Is this a different process, reducing core temperature for recovery? A global rather than local process? And not injury related?

    Reply
  4. Staci

    I am seriously interested in this follow up as I remember the last video- but I honestly cannot bear to listen to this with the announcer in the background- it’s mind numbing. I wish you guys had sat down in a more quiet location to address such a topical issue.

    Reply
    1. Gary

      “Iced! … The Illusionary Treatment Option” provides a good base to understanding the points below:

      During the past year, when discussing the topic of icing damaged tissue, I have learned to lead with the following information.

      1) Icing damaged tissue does not prevent inflammation it merely delays inflammation (by the way, good thing it does not prevent inflammation; if it did, the tissue would not heal. Related questions; “Why would you want to delay healing? Or more importantly, do you actually believe that you are more qualified to regulate your body’s natural healing process then your innate intelligence?”)

      2) Icing damage tissue does not reduce swelling (in fact, it will likely increase swelling)

      3) Icing damaged tissue does not accelerate healing (in fact, it will likely cause additional damage)

      Here’s a final thought to ponder;

      Seriously … do you honestly believe that your body’s natural inflammatory response is a mistake and/or that incapacitating your muscles will somehow (magically) improve lymphatic drainage?

      Gary
      garyreinl@aol.com

      Reply
  5. ketos

    How about heat then? Would soaking in a hot tub be beneficial for the improved circulation?

    Reply
    1. tRoy

      You would not want to use heat in the acute phase. I am not a Dr. but my experience comes from practical application working as a navy corpsman. Activation of the muscles is the best way to activate the lymphatic drain. Motion is the lotion when there is tissue being repaired and remodeled. It really is the most simple way of getting the garbage out and groceries in and recovering from a hectic workout or some injuries. The benefits of an EMS protocol like Marc Pro is that the muscle contraction doesn’t hurt. If you cause vasodilation, with heat, in the acute phase but don’t work to actively remove the fluid build up you can cause more swelling and associated pain in the tissues or joint.

      troy@cowboycrossfit.org

      Reply
  6. CGSnipe

    I have to agree with Staci… I wanted to listen to this, but the announcer in the not-so-background distracted me so much that I couldn’t focus on what you were saying and eventually turned it off. For a discussion this long and involved, it’s too much to ignore. Please consider revisiting some of these points in a setting with less background noise.

    Reply
    1. Mitch Tate

      The background noise chills out after a few minutes. I was concerned too, but the majority of the video is easily watchable. Plus, it’s much easier to understand Gary in this HD video with it’s superior sound quality (vs last time), background noise aside.

      Reply
  7. Brian

    Please cite the journal article you’ve mentioned. There have been studies cited in Nature that have been of bad quality, so I’d like to critique the article myself if possible. Awesome line of thought, though. I’ve always wondered the same thing growing up. I’d ask the same question, “How is our body’s natural response a flaw?” and my coaches and PTs would never give me an answer. I’ve found that using the compression (voodoo) on my sprained ankle 2 weeks after I hurt it, and swollen tissue immediately went away. Ice never did that!

    Reply
    1. Andrej

      Yeah, I second that, please reference the 2012 meta-analysis discussed, I can’t find anything on the web.

      Reply
      1. Brian

        Searching “ice” in “2012″, as well as recent years before and after, in the BJM archives yields little results, of which aren’t related to this topic.

        Reply
          1. Aaron

            Wow, this is incredible!! Thanks for sharing this Drew. To anyone who wants to make an informed decision on this topic PLEASE read this article! Had a few good chuckles reading it as well.

  8. Robert

    Great info and I’ve stopped icing after the first video.

    But….
    Now, It would be so much more helpful now to have one video where Kelly looks into the camera and states, icing doesn’t work because “xyz” (in laymen’s terms an athlete without a PHD could understand) and then say, what does work is “xyz”(in laymen’s terms an athlete without a PHD could understand). Using terms a trainer could use with his athlete or doctor could use with a patient, to help them understand. 5 minute video or less!

    Reply
    1. Mitch Tate

      The ;tldr is that icing just delays the inflammatory response, which is necessary for the exchange of waste for nutrients and the onset of healing, and can cause some degree of local tissue damage at the same time.

      Reply
  9. Jay

    I’ve been a crossfitter and m/WOD follower from the very early stages; bought the book remember the last video on icing. I’ve have never posted or commented or asked about any other topics covered, but I feel compelled on this issue. This past spring I pulled an Annie T! I didn’t want to, but when I lost the feeling in my foot and developed foot-drop, I had to have surgery! I’m 11 days out of surgery, and looking for some advice on how to get back (no pun) at it sooner rather later! The neuro that preformed surgery seems to be very old school, and has made comments that I won’t be able to crossfit like I used to.

    Reply
  10. Jeremy Bennett

    You mentioned something about Compartment Syndrome. Is icing pain in the case of compartment syndrome good or bad? I didn’t quite catch that. I’m a wildland fire fighter and we have seen a couple cases of Compartment Syndrome as a result of our physical fitness test (the Pack test- 3 mile hike with 45 lbs in less than 45 minutes). One case the individual almost lost his leg, the other a good part of his calf.

    Reply
  11. Jake Heikkinen

    Great videos Kstar!! I had questions on icing in school and all my professors and clinic advisors pretty much told me that icing was what was just done. I’m glad that you are challenging the way many health care professionals approach pain management and inflammation.

    Reply
  12. Pingback: STOP ICING! « Driven by CrossFit Temecula South

  13. Josh

    There are no absolutes in medicine and rehabilitation of the human form…
    There is a time and place for ice, heat, compression, etc.

    *** What is not being appreciated is that the innate immune/inflammatory response has not evolved to distinguish between pathogenic (i.e., bacterial) and traumatic (i.e., muscle tear) insults of the body… therefore slowing the initial inflammatory response MAY still be beneficial in certain situations. The research is far from conclusive on this topic with both temperature therapies having positive and negative effects post injury…

    Reply
  14. Tyler

    I had the pleasure of speaking with Gary for several hours at the NSCA’s National Conference this year. I watched the video you guys made a year ago and I was excited to see Gary at the conference. He allowed me to use the Marc Pro on my low back for a long while and we spoke about the process and Kelly at length. I am grateful to Gary for explaining the process to me in a language that was easy to understand. He is passionate about this and I believe he could talk about it all day! I am thankful for all of the work you two have done to get this out there to the masses. Another great video. Thank you!

    Reply
  15. Eric Voigt

    couple of physiological aspects of cooling tissue, it decreases nerve conduction velocity so the cns has less idea of whats going on ,its also messing the the somato topic map which may result in diminished ability to know the position of your joints reducing proprioception and shunt stability as well actually decreaseing the overall central integrative state of the sensorymotor system.Interested to know Gary’s opinion on fasting induced autophagy to clean up acute injury, It appears to be useful in cleaning up taopathy and lewybody goo in Parkinsons ,alzheimers and senile dementia .Keep up the good work,you guys rock!

    Reply
    1. Brian

      Thanks Bernd, but Gary mentioned a very recent article published in 2012. Let me know if you can find it!

      Reply
  16. Billy

    Thanks KStar for revisiting this issue. I also remember when round 1 of this topic came out on MWod last summer at the Games. I have resisted icing, and have purchased a Compex Sport electro-muscular stimulation (E Stim) unit for recovery, etc. I am wondering the differences between the Compex units and the Marc Pro.

    Has anyone used both and can talk about the differences, pros and cons? Thanks.

    Reply
  17. Mel

    Kelly, the posts are always interesting. But.

    You have to provide citation, so we can review the literature references being thrown around here. Also: “The body is always smarter.” – this argument is a black box, and not helpful for useful dialogue here. There are many cases where the body is not “smarter”.

    The issues are usually more subtle than a black and white – “ice” or “no ice”. Please let us all stay informed.

    Reply
  18. Nicholas Smith

    Could this be the 2012 meta-analysis?

    https://www.pubmedcentral.nih.gov/pubmedhealth/PMH0033934/

    Citation: Bleakley C, McDonough S, Gardner E, Baxter G.D, Hopkins J.T, Davison GW. Cold‐water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008262. DOI: 10.1002/14651858.CD008262.pub2. Link to Cochrane Library. [PubMed]

    Reply
    1. Mel

      I don’t think this is the meta-analysis referenced. As this study concludes that, “There was some evidence that cold‐water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention.”

      It would be interesting to see if the data are different in terms of the use of cryotherapy – in terms of the tissue being treated. Ice has never worked for DOMS for me, but I find it beneficial for joint and soft tissue pain. n of 1.

      Reply
  19. Pingback: Don’t Ice Injuries – Part Two | Ryan Iuliano Massage Therapy

  20. Brian Schultz

    Thanks for making this update. I found the video last year confusing and therefore unconvincing. This video is much more cogent and precise. I always found icing to be detrimental to my own recovery, but I was never comfortable debunking the practice to others. Now I am confident discussing better alternatives.

    Reply
  21. Matt

    had a hard time with Gary’s last name. I would like to follow up but cannot find his website other than marcpro that he mentioned in the podcast. can not find any mention of his book on the interweb either. anybody know where to look?

    Reply
  22. Chris Peterson

    I rehabbing from a traumatic lower back surgery. Low back is great but my thorasic and neck are a wreck from Not Moving per my Kineseologist. I have the Compex stim unit, any thoughts on neck placement????

    Reply
  23. Dana Vansant

    I’m a physical therapist and I haven’t used ice in years. My colleagues and patients have always thought I was nuts. Thanks for spreading the word and being willing to put yourself out there to buck conventional wisdom. Science and research trumps the CW every time man

    Reply
  24. Jennifer

    Thank you for the wonderful discussion; I am a professional contemporary ballet dancer now teaching pilates and at age 41 am facing bilateral hip replacement surgery. As there are arguments for using ice machines in initial cases of trauma, what are your opinions about using ice machines post-op? One dancer I spoke with swore by the ice machines and attributed her rapid recovery from bilateral hip replacements to the ice machine.
    Seeking advice for optimal recovery!!

    Reply
  25. Jude Temple

    How about some citations for the claims being made? I was waiting for the “close” with where and how you can buy something. If you are going to change the medical / healthcare community on this then there needs to be coherent aurguments with evidence to support those claims. I am willing to listen to new ideas, but I will only accept those that are logical and supported with evidence. Also, what are Gary’s credentials? PT, ATC, MD, DO? I watched this video and the one from last year but never a mention of why he knows what he is talking about. He seems more like a salesmen that you would meet in a booth at a national convention. I am not trying to be a hater just trying to be scientific about this.

    Reply
  26. Michael Grant

    Well, I am sure my friends will be pumped when I bring my ice machine home for margarita’s

    Reply
  27. Tyler Armstrong

    Just curious what makes the Marc Pro any different than a TENS unit or Russian Stim device. I know TENS is mostly used for temporary pain relief, but can’t you get a muscle contraction with that as well. It doesn’t seem like the Marc Pro machine is anything new or ground breaking in the world of electric muscle stim devices….Just a similar machine with a new trendy package and lots of marketing. I’m ears to consider trying one out, but Marc Pro’s website doesn’t say the specifics of their machine, and will not return calls or emails on that subject. $650 is a lot of money for the average joe to spend on decreasing their muscle soreness when there could be similar or identical machines on the market that are a fraction of the price. That being said, I find the concept of allowing the muscles to help speed up the muscle recovery process over icing very fascinating, and like most of you I would like to see some more scientific literature that supports these claims.

    Reply
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  31. WindKnot

    “Have you ever seen ice actually reduce swelling?”

    No! But I can personally attest to it INCREASING swelling. In order to bring that swelling back down again I used heat (which I imagine increased the circulation in that area and sped up the removal of all the “garbage”).

    Reply
  32. Pingback: No more ice! How to actually recover from injury | Ms Audacious

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  35. Eric

    I have had a similar train of thought on this subject for years. It is very difficult to get athlete’s, especially at the elite level, to go against what has always been the “norm”. While working as thread S&C coach for a pro basketball team in China, I was continuously having to try to argue the case of ice actually increasing the risk of further injury. The head medical trainer would apply ice MID-GAME to players for minor tweaks and pulls out impact injuries! It blew my mind. Even after explaining the physiology behind my reasoning, some guys would still ice on the bench then go right back in the game! I would be interested to hear your thoughts, (and anyone else’s on this forum), on temperature induced vaso constriction/dilation after workouts, (not for acute injury), to help facilitate the waste/nutrient exchange. I have found a regimen of cold plunge for several minutes followed immediately by hot tub/whirlpool soak several minutes repeated 3-5 times or so, post workout, to really help with recovery. This has been my own personal experience as well as the feedback from my many athlete’s I train. What do you think? Physiologically sound, or more of a mental placebo effect? Great video! I love when people use science to find new answers instead of just doing things because, “that’s what we’ve always done”, even if it bucks the conventional line of thought.

    Reply
  36. Pingback: Iced: The Illusionary Treatment Option: A Book Review | DrChrisBakerDC

  37. Pingback: ICE Controversy For Injuries? To Support Healing or To Simply Get Rid of Pain? Read about How ICE May be an Illusionary Treatment Modality | Opening our Minds - Interpersonal Communication

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  39. Lorenz

    I had a bruised knee and when I applied ice swelling decreased while my range of motion increased.

    Reply
  40. Pingback: 40 years between pull ups | CrossFit Helena

  41. Pingback: Inversion (Lateral) Ankle Sprain: Structures, Injury, Rehab, Repair - Back to the Box

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  43. Rasmus Bank

    It’s funny how we don’t realize these thing our selves.
    I broke both bones in my arm. Had it put together and put in a cast.
    The many following nights, i woke up during the night because my fingers were cold because of the swelling of the arm inside the cast.
    How did i fix this?, I MOVED my fingers, bend them as much as i could inside the cast, contracting my muscles and relaxed them, over and over again, until the swelling went down and i could go back to sleep.
    What you are saying is exactly that.
    Thank you for doing all of your videos, i have learned so much!
    Big fan of proven knowledge !

    Reply
  44. Sam Mannings

    What is the anti wasting hormone he mentioned couldn’t work out that he said! PGCA-1 or something like that?

    Reply

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