I was recently lamenting to a non-horsey friend about trying to find a pair of ice boots I liked that wouldn’t break the bank. They inquired more about what we used them for and how – and then proceeded to turn my world upside down. I’ve been a loyal ice-er for years of my horses (and self) – not after every ride, but certainly after a XC school, on any soreness, at a HT or a tough jump lesson. It’s good horsemanship, right?
Until she told me I might still be stuck in the 90s and… totally wrong? Apparently the most recent research is showing ice may not be the most beneficial thing for recovery. Think I’m crazy? Me too.
Because I’m good at writing about shoes, horses and spending money, but not great at science, I just straight up brought some quotes in to do the talking.
“The rationale behind recovery ice packs, baths and cold tubs goes something like this: the cold stimulates your sympathetic nerve fibers, which react by signaling blood vessels in the area to constrict and send blood back to your core to protect your vital organs. This rush of blood away from the extremities reduces blood flow to the areas you’re icing and slows the metabolic processes in these regions, including the inflammatory response, and thus reduces any swelling that might otherwise happen. The pressure of the water may also provide some compression against your muscles and blood vessels, which could also slow swelling and inflammation. Finally, icing relieves pain by numbing sore areas, at least temporarily… There’s no question that icing can reduce pain, at least temporarily, he told me, but it comes at a cost. “Anything that reduces your immune response will also delay muscle healing,” Mirkin says. “The message is that the cytokines of inflammation are blocked by icing — that’s been shown in several studies.”“Athletes love icing sore muscles, but that cold therapy might make things worse” – Washington Post
Instead of promoting the process of healing and recovery, icing might actually impair it, he says.”
In other words – sure, ice will numb things, but for how long and at what cost to performance?
“Gary Reinl, a personal trainer and prominent icing skeptic who over the years has worked with professional athletic teams, elite military squads and coaches and trainers around the world, says the problem is that icing merely slows blood flow to the area, it doesn’t halt it indefinitely. Once the icing stops and the blood flow returns to normal, whatever process you were trying to hinder will proceed again. The swelling will continue and the inflammation will start. The only thing you did was delay things, he says.”“Athletes love icing sore muscles, but that cold therapy might make things worse” – Washington Post
Well. Huh. So I decided not to take this at face value and to use my university journal access to dig myself. And… sure enough, that’s what I found.
“There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment.” – The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials, American Journal of Sports Medicine
“The authors reported ice to be no more effective than rehabilitation only with regard to pain, swelling, and range of motion. Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain. Additionally, ice, compression, and a placebo injection reduced pain more than a placebo injection alone. Lastly, in 8 studies, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Only 2 of the 8 groups reported significant differences in favor of ice and compression.” – Does Cryotherapy Improve Outcomes With Soft Tissue Injury?, Journal of Athletic Training
“Cold packs were applied to exercised muscle for 15 minutes at 0, 3, 24, 48, and 72 hours after exercise. The exercise significantly elevated circulating creatine kinase-MB isoform (CK-MB) and myoglobin levels. Unexpectedly, greater elevations in circulating CK-MB and myoglobin above the control level were noted in the cooling trial during 48-72 hours of the post-exercise recovery period. Subjective fatigue feeling was greater at 72 hours after topical cooling compared with controls. Removal of the cold pack also led to a protracted rebound in muscle hemoglobin concentration compared with controls. Measures of interleukin (IL)-8, IL-10, IL-1β, and muscle strength during recovery were not influenced by cooling. A peak shift in IL-12p70 was noted during recovery with topical cooling. These data suggest that topical cooling, a commonly used clinical intervention, seems to not improve but rather delay recovery from eccentric exercise-induced muscle damage.” – Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage, The Journal of Strength and Conditioning Research
“Significant training effects were three times more frequent in the control than in the cold group, including increases in artery diameters in the control but not in the cold group. It is concluded that training-induced molecular and humoral adjustments, including muscle hyperthermia, are physiological, transient and essential for training effects (myofiber regeneration, muscle hypertrophy and improved blood supply). Cooling generally attenuates these temperature-dependent processes and, in particular, hyperthermia-induced HSP formation.” – Post-exercise leg and forearm flexor muscle cooling in humans attenuates endurance and resistance training effects on muscle performance and on circulatory adaptation, European Journal of Applied Physiology
Similarly, a 2015 study reported on two experiments looking at how cold water immersion influenced how muscles responded to a strength training program, and found that cold treatment reduced gains in muscle mass and strength and blunted the activation of key proteins in the skeletal muscle. The studies “challenge the notion that cold water immersion improves recovery after exercise,” the authors wrote.“Athletes love icing sore muscles, but that cold therapy might make things worse” – Washington Post
So – definitely a conclusion saying more research is needed, but also not an insignificant amount of research saying that cold might be doing less good than we thought, or even hurting recovery?
Needless to say, this has my little brain spinning. Do I keep using ice? Stop using ice? Only compression? I haven’t come to a complete conclusion yet. Not to mention, a lot of these are talking about muscle recovery – a moot point in horses who have no muscle below the knee.
For now, I’m going to continue to ice after XC schooling and at horse trials, but maybe lay off after any general rides, even if they’re harder jump schools.
Can I say that I am a “bad eventer” and never ice? I have cold hosed on occasion, but honestly, I prefer just to wrap (i.e. compression) until I can turn May out. Obviously, we aren’t doing anything high level, but it works for us!
So one thing I notice is that these studies seem to refer to the effect of ice on muscle fibers. I know I don’t ice anywhere near muscles, I ice near tendons – from what I understand, more quickly dissipating heat from those areas is the goal, not preventing muscle soreness. I’m now going down the article rabbit hole to see what studies are more specific to those tissues!
Right. Definitely something I thought about too, but still makes you wonder. Specifically the one on ankle injuries. But I wonder if cold hosing to dissipate heat quickly vs ice boots after a hard ride (like a lot of eventers seem to do) have different intentions at heart.
This is fascinating. I have never iced. I do cold hose though after every ride when it’s warm. Mostly to remove sweat but I do pay attention to the legs. I wonder too with horses who have no ability to expand in the hooves if cooling the bloodflow will reduce issues with laminitis?
So many questions.
Interesting. I often wonder how many traditional things we do that research can prove are not effective. I never used ice on the legs when doing endurance and that carried over to now with eventing though I am at 2′ so it isn’t super stressful on the legs.
I was hoping you’d see this! I wanted to hear your thoughts on the idea and the research since it seems right up your professional alley!
My issue has always been the key you mention – the muscle factor. Since horse’s legs have no muscle, no correlation can be made between horses and humans in this case IMO. We need more studies relating directly to horses.
so i’m still learning the finer points of what needs to happen to maintain an event horse. as such, i often ask riding buddies, lesson mates, trainers, etc, how they manage things like post-care.
for instance, after one of my last xc lessons i asked my two lesson mates what their plans were. we had all jumped predominantly T fences, tho the other two had done a fair amount of the M course as well. both of them have ridden multiple horses at higher levels too, and have substantially more experience than me and were riding horses with substantially more mileage than Charlie. and both said that they didn’t consider this particular ride as necessitating icing. from their perspective, it’s the sustained galloping that’s likelier to produce the inflammation vs just jumping. and so in this standard schooling ride where we started and stopped often, they didn’t see a need. had charlie been going into a trailer or stall after the ride, then maybe i would have done standing wraps. but he was being turned out, so they didn’t see any reason to delay his freedom lol.
honestly tho, i see stuff like this as falling pretty squarely into the “ask 2 horse people, get 3 answers” category. my general approach is less about reading the research, per se, than it is learning from the horse people i trust and respect – esp those whose horses are still able to perform happily as they age.
I honestly don’t ice that much. When I was jumping big jumps I used to do poultice sometimes but mostly did a brace and a standing wrap. I agree with most that more research is really needed to know if it’s better or not.
With injuries, I like to ice. My vet said with Pammon’s injury ice for the first two weeks was great, but was pointless after that. He has a torn check. Doc said wrapping was the best thing for it. And suggested arnica gel for under the wrap.
Moar back on track stuff lol