Giving Ice the Cold Shoulder
Diane Gross, L.Ac.

Patients with chronic pain resulting from a previous injury often ask, “How often, and for how long, should I apply ice?” My answer often surprises people. I tell them I typically wouldn’t ice an area of chronic pain! Unfortunately, regular icing seems to have become standard practice as part of an ongoing “self-care” regimen for chronic pain, especially if it stems from an acute injury. While there may be some short-term relief from nagging symptoms, I have often seen this approach have long-term repercussions.

While we are all familiar with the RICE approach to treating an acute injury – Rest, Ice, Compression, and Elevation – I think this protocol has been mistakenly generalized to the treatment of chronic issues. There is a time and place for therapeutically icing an injury, however in Traditional Chinese Medicine (TCM) ice is used sparingly and as a short-term intervention. Even in Western Medicine, the protocol for icing an acute injury is generally for the first 48-72 hours. From a TCM perspective, overuse of ice, even for an acute injury, can exacerbate symptoms, and can even create a chronic condition.

Many of us have been taught that swelling is “bad” and must be eliminated. I wonder if this idea is a response to our cultural propensity to focus on symptoms, rather than the cause of symptoms. We may not stop to consider that swelling can serve a purpose! Actually, the swelling mechanism is a very important aspect of the healing process. Swelling results from nutrient and enzyme-rich fluids that bathe an injured area.  These fluids assist in the healing process and provide natural “splinting” for protection. The body is so wise! If these fluids are blocked, then the healing process is impeded and the injury is more likely to become a chronic problem. This is not to say ice should never be used. Ice can be invaluable when used in a timely and targeted way. Certainly it can help control pain due to a recently traumatized area, or help reduce severe swelling that may be cutting off circulation. The problem arises when ice is used too much, or for too long a period of time.

From a Western medical approach, ice is thought to keep swelling and inflammation down, while heat is thought to increase inflammation. In contrast, TCM teaches that ice actually decreases blood circulation as it reduces inflammation, while heat increases blood circulation. This is an important distinction. While the application of heat may not always be appropriate, especially if the area of concern is red or hot to the touch, that doesn’t necessarily mean the application of ice is appropriate as an ongoing or dailytreatment approach. If the painful area is cold or stiff, then careful application of mild heat, for short periods of 15 minutes or less, may be useful to help increase the circulation of qi (energy) and blood in the local area. This brings oxygen and needed nutrients to the injured site and flushes out acids that may have accumulated in the tissue. In this way, warmth may actually assist in the reduction of swelling, as well as help prevent the development of scar tissue.

Chinese Medicine tends to look at nature to learn about the internal workings of our body. In nature, we find ice slows things down; it hardens. TCM maintains that our body responds to ice in much the same way. Ice slows the movement of fluids and qi, decreases blood circulation, and hardens tissue. In nature, movement is essential for life. Likewise, in our bodies we find movement of qi and blood through the injured area is also vital. When this flow is diminished or blocked, it can lead to “stagnate” qi and blood. This is important from a TCM perspective, because where there is stagnation, there is pain. Icing just temporarily addresses the symptoms, while establishing the free flow of qi and blood assists in the actual healing process.

So how does this apply to the person who may experience ongoing symptoms of chronic pain stemming from an injury? I stated that ice should typically be reserved for the first 24 hours of an acute injury. So when it comes to treating symptoms, how might we define “acute”? Acute conditions tend to be severe and sudden in onset, while chronic conditions usually develop over time. However, it is possible to have an acute attack in the midst of a chronic syndrome, especially if there is an underlying “root” weakness in the body’s energetic system, insufficient recovery time before resuming activities, or if poor ergonomics or other exacerbating factors are at issue. This is the situation a lot of people face. Even so, the continual application of ice can cause a stagnation of qi and blood, thereby blocking the healing process. This can create and perpetuate a vicious cycle. It may be likened to someone taking Ibuprofen daily for headaches, who then begins to experience Ibuprofen-induced “rebound” headaches. A cycle has been established that may be difficult to break.  

The goal must be to address and remediate the root cause of the condition, not just symptoms of discomfort and swelling. As such, it is important to implement a multi-dimensional program designed to strengthen the body, as well as nourish and encourage the healthy flow of qi and blood. Acupuncture and Chinese herbs can be an extremely important part of such a program. These modalities are designed to help harmonize and balance the flow of qi and blood in the body. When qi and blood are flowing freely the body’s natural healing process is engaged, and pain and swelling naturally decrease.

Diane Gross, L.Ac., Dipl. OM, CI, CT, is a licensed Acupuncturist at Stillpoint Acupuncture and a nationally certified sign language interpreter. Call 336 510-2029 for more information or visit www.stillpointacupuncture.com.