Detailed guides to painful problems, treatments & more

Icing is still useful: a rebuttal to cryotherapy skepticism

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

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You just never know what’s going to take off on social media. I shared this image with the explanation, “New featured image for ‘ice vs heat’ topic”:

Photograph of vintage water faucets labelled hot and cold, representing cryotherapy and thermotherapy.

That’s it. That’s all there was. I didn’t update this or any related article (on this occasion anyway). It was a really minor sharing. Whoop-de-doo!

But it just took off, by my (modest) social media standards. The tweet generated 100× more attention and traffic than many more substantive tweets — including many I really wish had done better that this one. 🤷🏻‍♂️ Weird. Good! But weird.

Speaking of things that I wish were more popular, I’ll take this opportunity to quote a key passage from my icing article …

Isn’t inflammation healthy? A brief rebuttal to a popular argument against icing

It has been fashionable lately to scoff at icing as a treatment because it allegedly interferes with natural healing, which includes inflammation — you don’t want to suppress natural healing, now do you? The physician who first proposed the well-known RICE rehab protocol back in 1978 has actually recanted the I-for-ice part, declaring in 2015 that “icing delays recovery,” and his opinion is now cited almost everywhere this topic is discussed. (He doesn’t seem to have written anything else about it since then.)

Dr. Mirkin’s article is brief and only tackles the claim that ice promotes healing. That is a popular idea, and it’s an important one to think critically about, but there’s much more to the topic of icing, and most icing is not done to “promote healing.” The much more common goal is just to control pain cheaply and safely, and that is not a baby I want to throw out with the bathwater: pain relief can be precious!

Ironically, after devoting a few hundred words to discouraging people from icing, Dr. Mirkin actually concludes his article by recommending small doses of early icing for pain relief — which most people citing the article don’t seem to have noticed.

I often see Mirkin’s article cited on social media to support the broad assertion that “icing is useless.” Clearly that’s a bogus citation and a ridiculous overstatement. Not only does icing clearly have a significant benefit that has nothing to do with promoting healing, but there are also major problems with the argument that it “interferes with natural healing.” Read more.