Is cryotherapy (icing) bad for you?

Applying ice to injuries has been a practice of mine since before I can remember. Some coach told me to throw an ice bag on a banged up knee and it’s something I’ve done ever since. Recently the logic of icing, or cryotherapy, has come under attack from an unlikely source. Kelly Starrett, of Mobility WOD fame, recently followed up an interview with a questionable blog post attacking icing. His posts left more questions than they answered. The overall theme of the interview and subsequent post is that icing injuries is bad because it interferes with the body’s natural ability to address inflammation. To support his position, Mr. Starrett cites two studies as well as an interview with Gary Reinl, the Director National Accounts and Professional Athletic Teams at MARC PRO. Let’s look at the presented evidence.

The first study, The Use of Cryotherapy in Sport Injuries, from 1986, simply states that prolonged exposure to extremely low temperature cryotherapy (less than 15C) may increase inflammation and oedema. The study goes on to note the highly subjective nature of cryotherapy. Cryotherapy results may be impacted by type and time of application as well as initial temperature of the affected area. Interestingly, the study goes on to claim localized icing increases blood flow in the affected areas. Starrett’s reference contradicts several of the facts presented in the study and appears to be taken out of context.

If there are some problems with the references Mr. Starrett takes from the first study, his points from the second study make less sense. The second study is a literature review of six other cryotherapy studies. The authors immediately dismiss four previous studies based on poor research; another is inconclusive. However, the final study has an interesting result. This last study indicates cryotherapy may “hasten a return to participation.” Isn’t speeding recovery exactly the point of icing injuries, which is what 50% of the valid studies indicated? The literature review may not have been conclusive either way, but it certainly didn’t close the book on the benefits of cryotherapy. “Inconclusive” doesn’t mean wrong – it means inconclusive.

The final piece of evidence Mr. Starrett uses is an interview with Gary Reinl. Mr. Reinl is associated with MARC PRO, a company with an obvious profit motive in selling you a non-cryotherapy recovery tool. (The MARC PRO retails for $650. Ice comes out of my freezer.) It’s hard to take Mr. Reinl’s comments seriously since he’s clearly not an unbiased source. There doesn’t appear to be much hard science behind the “icing is bad” theory presented by Mr. Starrett and Mr. Reinl.

Is ice suitable for every type of injury? Of course not. In fact, research seems to be inconclusive regarding the benefits or consequences of icing in the first place. But cryotherapy may have applications in your recovery strategy. Knowing what to ice, when to ice and for how long is essential to using it correctly.

Note: I’m a huge fan of the work Kelly Starrett does in the athletic community. His methods and techniques have greatly helped my own performance as well as countless others. That said, his unfounded opinions on cryotherapy undermine his credibility.

One single comment

  1. Clayton Foschiani says:

    Hi Nick
    Good to hear someone was intrigued by it as well. I am great fan of Starrett too, but did not know what to think when I saw that video. I have knee osteoarthritis and cannot remember when I started cryotherapy as a way to calm it down. I told about this ideas to some physical therapists I know here in Brazil (I am not one, but eventually, because of that injury, I came to know some of the best ones) and they were confused with the thesis, because there seems to be some sound physiological arguments but the lack of evidence or/and the way they are being presented seems to be pretty much distorted. I caught myself wondering if there would be any other motive, until I found your post, linking Marc pro and Mr. Reinl. It is understandable to me when Mr. Reinl openly criticizes the pharmaceutical business, but it was very very weird when he said that “the ice industry was huge”. Anyway, just wanted to thanks for your comments on that video, it helped me a lot. I guess it is hard when a personality like Starrett comes publicly on a topic like that and spills out something without much thought on it, right?

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