TCM: Ice is for Dead People
In the paperback, A Tooth from the Tiger's Mouth: How to Treat Your Injuries with Powerful Healing Secrets of the Great Chinese Warrior, we learn that a sprained ankle is best treated with heat. “Ice is for dead people,” the instructor bellows as one of his students runs to fetch ice for an injured classmate.
For many years in the west we have been taught an acronym for all types of injuries. This saying has permeated the teachings from medical doctors to first aid classes:
Rest
Ice
Compression
Elevation
Do you know who created this acronym? Dr. Gabe Mirkin. The full article can be found here, but I will save you the time by pasting key parts.
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.
For 37 years RICE has been used as the standard. On September 16, 2015, Dr. Mirkin said he was wrong.
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.
Lastly, he goes on to say that anything else that reduces inflammation will also delay healing, and that cooling reduces function, while warming returns strength, speed and coordination.
Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete's strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.
We know in the world of Chinese Medicine that heat is the preferred method of healing for acute injuries. Ice was chosen because of its ability to decrease pain. In the west we tend to move away from discomfort - but that is where the magic is.
Placing heat on a sprained ankle will cause even more discomfort. The body knows exactly what it is doing by bringing heat and swelling to the area. Why should we believe that we are smarter than our bodies? Instead of fighting against the bodily processes we can help them by adding more heat to the area which speeds healing.
Placing ice to simply decrease pain is not a good enough excuse. In fact, once the joint, muscles, tendons, channels and collaterals are damaged due to injury there is a larger chance for Cold and Dampness to enter. This phenomenon is seen many times over in clinical practice. Placing ice at the site of injury will bring it in direct contact with Cold!
There is an exception to this rule, however even this must be soundly expanded on. In chronic cases where Heat Bi is found care must be taken not to add heat to the site. It is still important, again for chronic cases, to ask the patient whether Heat, Cold and/or Dampness makes the pain worse. In speaking of the use of moxibustion there is the thought that to cure a poison a stronger poison must be used. Moxa is often recommended for Heat conditions, but the penetration method must be used (strong heat for a long period of time - 45 minutes or more until the patient reports a feeling of warmth penetrating to the other side of the body part). It is said that if no other therapy can help, use moxa. If one is not comfortable with this method, needling and cooling and quickening topical herbs can be used.
As ambassadors of Chinese medicine I believe it is our duty to educate our patients properly in the care of their own bodies. It matters what time they go to bed, what foods they eat, how much they exercise, and what methods they use for healing injuries at home. Nothing is better than a magic bean bag or a hot water bottle for self-care.
I still see Chinese medicine practitioners recommending ice to their patients. I wonder why. We have 5000 years of Chinese medicine history to back up the use of heat. Even Dr. Mirkin recanting his statement from 41 years ago, backed by many studies, rings true.
As ambassadors of Chinese medicine I believe it is our duty to educate our fellow practitioners.