Should you use ice as a treatment for your Tennis Elbow? - No. Here's why you should use heat instead or at least stop icing!
"Am I joking!? – What about the inflammation? you're probably wondering... All the medical websites and authorities say I should ice my Tennis Elbow to reduce inflammation! Could they all be wrong?"
Podcast: Forget Ice Therapy For Treating Your Tennis Elbow
Here's an improved, better-sounding version of the "Should You Ice It?" podcast that you can download and keep by clicking the "download" link under the player below:
Why The Whole Idea Of Using Ice Therapy To "Treat" Tennis Elbow "Inflammation" Is Just Plain Wrong
- Inflammation is NOT the real problem with Tennis Elbow,
- So, icing probably won’t help your elbow heal,
- And ice may actually slow your recovery instead...
When it comes to Tennis Elbow, as well as many other tendon problems, the reason there’s usually no benefit to icing it – (OR trying to chase it away with anti-inflammatories or Cortisone shots!)
Is because inflammation is actually part of your healing process...
What happens, any time you injure something, is that the healing process kicks in and inflammation is the first step in that process.
Now, sometimes when you have what they call an 'Acute Injury,' you get a lot of swelling, and in that case there is some benefit to using ice, right after the injury to reduce the swelling
BUT, 'Acute Injuries' are almost always sudden, traumatic injuries, often involving some bruising or tearing – like a sprain or a strain.
And, although Tennis Elbow can sometimes start out this way – Most of the time it creeps up on you – It’s usually a sneaky, gradual breakdown.
For a good example of an “Acute Injury” let’s take an ankle sprain…
Have you ever sprained your ankle badly – or seen someone who has?
You’re almost certain to see some swelling from the inflammation kicking in hard and fast, and there’s no debate that putting some ice on that is the right thing to do
Let me repeat that “swelling” is the bad thing here. It means there’s too much fluid building up in the area.
And you can tell because it puffs up visibly and also feels kind of spongy when you press on the area.
And that’s not a good situation because it means the area has gotten all clogged up and congested – and your circulation has slowed way down – It’s bad because you need good circulation for healing!
Swelling is NOT the feeling of tenderness, soreness or pain OR the presence of redness you can see in your skin – Although those symptoms often go along with it.
Swelling is really only the build up of fluid
So, the question is: Can you see any swelling around your elbow?
Does it feel significantly puffy to your touch in that area?
Now, I’m not trying to diagnose you here, but if you don’t see it, there’s probably no significant swelling you need to be worried about.
And icing won’t do a thing for you except make your pain feel a little better for a little while.
Of course that’s better than popping anti-inflammatories – BUT the bottom line is, it won’t help you heal any faster, and if you do a lot of icing – It may slow your healing down!
As a side note, I’ve been treating Tennis Elbow cases frequently for at least seven years in my practice, and I can’t remember ever seeing one person who had any significant swelling around their elbow.
Is RICE Wrong? Questioning The Whole Protocol
Word seems to finally be spreading and prominent trainers and other sports, rehab and therapy professionals are recognizing that the RICE protocol is not only useless for chronic conditions, (like Tennis Elbow) which aren't even inflammatory...
But that RICE and especially the ice part is also potentially counterproductive for mild-to-moderate Acute injuries! (At least beyond the initial minutes following a sudden injury.)
One of the most visible (and quoted) sources is the Doctor who coined the RICE acronym in the first place, who has since radically changed his position on it.
Doctor Who Coined The Term RICE Has Reversed His Position
Dr. Gabe Mirkin, co author of 'The Sports Medicine Book' from 1978, now says that:
Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping. And he points out that:
- Gabe Mirkin, MD Why Ice Delays Recovery
- Healing Requires Inflammation - And
- Anything that reduces it also delays healing!
Joshua Stone, a heavily-credentialed Athletic Trainer has an excellent series on RICE and icing on his blog at StoneAthleticmedicine.com (links in G+ post below.)
Most of it is not specific to Tennis Elbow treatment but the same principles apply for the most part. He tells us in '10 Reasons – Icing Injuries is Wrong' that:
- Joshua Stone, Stone Athletic Medicine - 10 Reasons – Icing Injuries is Wrong
- "You cannot have tissue repair or remodeling without inflammation,"
- "Ice constricts blood flow and impedes the inflammatory cells from reaching injured tissue."
- "Inflammatory cells are designed to release a hormone known as Insulin-like Growth Factor (IGF-1)" [But ice inhibits this essential healing component]
In this video Kelly Starrett (of MobilityWOD on YouTube, and author of 'Becoming a Supple Leopard') interviews Gary Reinl (Author of 'ICED! The Illusionary Treatment Option')
At one point, Gary, describing a conversation he had with a pro football trainer about ice and the “goal” of reducing inflammation, asks:
“Are you under the belief that your body doesn't know how to regulate that?... You think you need to 'regulate' the body's inflammation response? You're better at it than the body is?”
And later on he poses the rhetorical question:
“Could the body's natural inflammatory response actually be a mistake!?... If it's not a mistake, and it's right, then why are you preventing it?”
I was also delighted to see that Gale Bernhardt, the U.S. Triathlon team coach at the 2004 Athens Olympic Games, seems to have also "switched sides" and now plays for the "RICE is wrong" team, according to her article on Active.com, where she references both Gary Reinl's and Dr. Gabe Mirkin's books.
OK, let’s quickly sum it up now:
- Inflammation is the first step in your healing process – And you can’t have any healing and repair if it doesn’t happen.
- If there’s raging inflammation that’s causing a lot of actual, visible swelling – then icing it down a bit to reduce the swelling may be helpful, (Although even that may now be questionable!) (But this is usually only right after an acute, traumatic injury – and typically not in most cases of Tennis Elbow.)
- If there is no swelling – only redness, pain, tenderness, and similar symptoms – then you could use ice to make it feel better, but if you overdo it, you may unintentionally slow your healing process down
And if you unfortunately succeeded in stopping all inflammation – with ice, anti-inflammatories and Cortisone shots – then you’ve basically stopped your healing process (they never tell you that do they!?)
That’s why, in my opinion, I think it’s best not to ice at all, unless there’s obvious swelling.
If you’re tired of chasing your Tennis Elbow symptoms around in a vicious circle following the latest remedy, trick or cure – You’re in the right place to get the big picture, to understand how your healing process really works, and learn how to help your injury finally heal.
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