IT SEEMS to be a week of sprains in the basketball world. You may have heard that Trae Young had to hobble out of the 2nd quarter in today's Heat-Hawks match-up, while San Miguel's Dez Wells rolled his ankle last Sunday. When you hear things like this happen, you might think that icing the injury would be the best way to recover. (That's actually exactly what happened with Wells, who got iced up in the San Miguel dugout after his sprain.)
That's certainly what I picked up early on in my line of work. When I started my career as a strength and conditioning coach, ice was the answer for almost all acute and minor injuries. It was used before and after a rehab session, by most pro basketball players after training and games, and was prescribed by PTs and doctors for treating injuries at home. You would hear it after every hurt: "Ice it for 15 to 20 minutes every 2 to 3 hours."
But now, icing as a means for healing injuries and faster recovery has been taking a hit, especially with a lot of scientific studies showing that it is no better than placebos. In some cases, it may even delay long-term tissue healing. This is based on the fact that inflammation after an injury or a hard workout is normal for the body. More blood flow to the injured area increases the transportation of many inflammatory cells and nutrients that help tissue healing, including macrophages that release a hormone called Insulin-like Growth Factor Number 1 (IGF-1) which is a key factor in tissue repair.
Even the inventor of the R.I.C.E (Rest, Ice, Compress, Elevate) protocol has called for a stop to icing because using cryotherapy (the fancy term for using an ice bag, submerging a body part or your whole body in an ice bath, or using one of those fancy but ridicolously expensive cryotherapy chambers), after an injury or intense exercise causes blood vessels to close, which delays normal inflammatory healing processes. In short, it supposedly stops the healing process from starting.
So in light of current research (and common sense), I will try to present to you when you should use cryotherapy, and when you should not.
First of all, we need to change our mindset that all inflammation is bad. It is, in fact, a helpful and posiitve process, especially after injuring yourself. If your PT or doctor still tells you that you need to get rid of all inflammation by using a combination of ice and anti-inflammatory (NSAIDs) meds, it might be time to get a second opinion.
However, we need to take into consideration that ice does not affect or reduce the inflammatory process that much. Comparing the effects of ice to NSAIDs or even steroid injections is like comparing a sip of Cali Shandy to a whole bottle of Bacardi 151. Using ice for 15-20 minutes may impede blood flow temporarily, but it won’t affect healing in the grand scheme of things.
The Kevin Hart digital talk show Cold As Balls takes icing to the extreme.
Another thing to take into consideration is that it doesn’t help or harm performance significantly. Recent research on cryotherapy for recovery has shown that it does not do any harm, but it might help if the athlete believes it works. The truth is that majority of your body’s recovery depends on sleep, nutrition, and hydration. Cryotherapy, massages, stretching, and all the rest are just the tip of the recovery iceberg... even if that's what we often see on social media.
The one good thing about using cryotherapy (and I’m talking specifically about ice pack, not those expensive chambers and cold plunges) is that it is a cheap and very effective way to reduce pain. It’s a good local anesthetic with no side effects. So if you injure yourself and the injured area hurts like hell, go ahead and use an ice bag if it helps you tolerate the pain better. Don’t use it all the time, so you slowly increase your pain tolerance, but it can be a handy tool for a safe and quick way to reduce pain in an injured area right after the injury occurs.
Now, instead of applying ice hours or days after an injury, just rest it until you can start to tolerate movement again. Once movement is pretty much back to normal, try to do some strengthening exercises for the injured area, then eventually return to your sport or activity of choice.
Julio Veloso is a graduate of the University of the Philippines (Bachelor of Sports Science) and the University of Sydney (Masters in Exercise and Sports Science). He has trained athletes from high school, college, and up to the professional level, including several UAAP and PBA teams.