ICED! The Illusionary Treatment Option - Second Edition by Gary Reinl
My rating: 2 of 5 stars
So one of my all time favorite writers is Shirley Jackson who happened to write my all time favorite short story that also happens to be the most anthologized short story ever.
"The Lottery" is a chilling tale that speaks to the darker side of tradition. The story begins with what appears to be preparation for some sort of seasonal celebration. Yet little by little the reader begins to understand the true sinister nature of the event called "the lottery." As part of this longstanding ceremony the people of this community draw straws to see who in the small, simple, little community will win the privilege of being stoned to death by their fellow citizens.
As the story unfolds, it becomes clear that many of the townsfolk are beginning to tire of the strange observance, most completely oblivious to the origin of the ritual, but no one particularly motivated to question its existence, let alone abandon it.
Interestingly, the story was so provocative, as is much of Jackson's writing, that when it was first published in 1948, the New Yorker was inundated with letters from readers wanting to know if the community in question was a real place and this bizarre "lottery" an actual celebration. Others, excepting it as fiction, simply wanted to know what the story meant.
Shirley, however, refused to break it down, stating only that the story spoke for itself.
In the end, I believe she was commenting on all the things we do, from the silly to the downright barbaric, that have no real justification other than they have always been done.
And that is essentially the premise of "Iced" which speaks to the unsupported use of ice to treat injuries.
According to the author, the practice not only lacks any real scientific support, its origin, using ice on an injury, had nothing to do with controlling swelling, pain, or treating acute injury. It came about as a means to preserve a severed limb so as to allow a reattachment.
And like many things that have no scientific basis but are nonetheless perpetuated, the practice of icing quickly caught on, eventually becoming the go-to treatment for any acute injury.
Reinl argues that not only does ice not help, it may actually be detrimental in that it retards healing, and he bases his argument on our understanding of how the body heals. He claims we use ice to reduce swelling, but all we really accomplish is to delay the inflammatory response (an essential component of healing) and make it harder for the lymph system to get rid of swelling (or the back up of waste that is associated with the inflammatory response). The only way to promote healing and to increase circulation and lymph drainage is through muscle activation. In that regard it would seem the advice to "walk it off," is more than simple conventional wisdom.
As a PT and as a person who hates cold, I've never been a big fan of icing, and I have always been an advocate of movement. That said, ice is everywhere in the rehab world, except, thanks to Reinl, in professional team training rooms around the country.
He makes some good arguments against the use of ice. Unfortunately, his alternative is muscle stimulators, as it appears they are the next training room panacea. He spends a lot of time offering useless protocols that seem like a waste of space as they are all pretty much the same, and basically offer little to the reader who wants to know why they shouldn't use ice. I wish he would have spent more time providing the science for his stimulators so as to distinguish it from unsubstantiated treatments like cold.
The book is long-winded with way too much fluff, boasting, and name dropping, so let me sum it up and save you a few bucks and a few hours. Just because we do something and have done it for a long time, doesn't mean it is the right thing to do. Throw your ice packs away. Icing an injury works against the healing process, is neutral at best and harmful at worst. Buy stock in muscle stimulators because if Reinl has his way and ice is no longer so nice, trainers around the world are going to have to fill their now empty training rooms with something.
I have mixed feeling about Reinl's claims. I agree with the idea that icing may actually work against the inflammatory response. It's like taking ibuprofen or Tylenol when you have a fever. You may feel better, but you ultimately interfere with the body's natural response to an infection or virus. The reality is if you can bear it, in many circumstances you may be better to let your body do what it has evolved to do. But taking Tylenol when you have body aches so that you can get some rest doesn't necessarily mean you won't get better. In fact, the rest you get might be critical to your recovery, despite the meds having suppressed the fever. It's sometimes the lesser or greater of two evils. Likewise with ice, there are times where I think the pain relief ice offers may actually support more movement which is ultimately a good thing. Basically, I think Reinl's argument is just a little too simplistic and idealistic. And of course, that means it will spread like wild-fire in the fitness community. All the fitness gurus seem to love debunking one "fad" to make room for another. Trainers will gladly ditch their ice machines for muscle stimulators and the guys peddling the ice paraphernalia will switch gears and be happy to sell it to them.
Ironically, Reinl repeatedly reminds us that the who's who of the sports world is on board with his anti-icing mantra, as if that somehow means anything when you consider these are the same elite group of guys who bought into icing, even perpetuated it, in the first place. I'm not sure their stamp of approval means squat.
There you go.