Swelling helps healing, so are ice and NSAIDs bad?


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Lots more to come from the sports nutrition conference in Canberra, but first I just wanted to quickly put up a link to my article in today’s Globe about new research suggesting that swelling may help injuries heal faster:

Every weekend athlete knows the RICE rule for dealing with minor sprains and strains: rest, ice, compression and elevation, with the latter three tactics aimed at minimizing inflammation.

But a study published last month by researchers at the Cleveland Clinic adds to growing evidence that swelling actually plays a key role in healing soft-tissue injuries. The result is a classic tradeoff between short-term and long-term benefits: reducing swelling with ice or anti-inflammatory drugs may ease your pain now, but slow down your ultimate return to full strength.

“This whole discovery has really thrown into question all of our traditional approaches to treating injuries,” says Greg Wells, a University of Toronto exercise physiologist who works with national-team athletes at the Canadian Sport Centre. [READ THE WHOLE ARTICLE…]

10 Replies to “Swelling helps healing, so are ice and NSAIDs bad?”

  1. Can you please post the study from the Cleveland Clinic? How do people keep mentioning studies and get away with not actually posting the study?

  2. “The resulting dilemma – feel better now or recover more fully later – is similar for elite athletes using techniques such as ice baths to help them recover after strenuous exertion, Dr. Wells says. In the middle of a tournament or after a qualifying race, recovering quickly is vital. But recovery from the wear and tear of daily workouts is a different story.”

    Is there more you can share on the post-workout ice bath question?

  3. John, I don’t think there’s any solid research on the long-term performance effects of ice-baths. But it’s an idea that’s popping up in a lot of different contexts right now (e.g. the current fad for doing some endurance sessions in a purposefully glycogen-depleted state to stimulate greater adaptation). The thinking is basically that a post-workout ice bath (or, say, a pre-workout energy drink) makes that workout a little “easier” in terms of the stress the body is adapting to, so it doesn’t adapt as much. The result is you do great workouts but don’t improve as much over the long term.

    Whether that will turn out to be true is still anybody’s guess. But here, for instance, is a scientist from the English Institute of Sport on the topic:

    “There’s evidence to suggest that if you constantly decrease the stress in training that the body won’t adapt, so long term use of a recovery technique, such as an ice bath, should be reviewed to avoid any detrimental effects on performance and to ensure that these techniques have their biggest impact when needed during competition” he adds.

  4. I think the key is in this sentence from the press release:

    “For wounds to heal we need controlled inflammation, not too much, and not too little,” Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal.

    My view is that in sports, we (we? the media?) go from one extreme to the other. Not surprisingly, the equilibrium lies somewhere in between. Compare the above sentence from Mr. Weissmann with the title of the same press release: “Surprise: Scientists discover that inflammation helps to heal wounds”… Obviously, the title is misleading.

  5. Great point, Andrea — the gap between the press release and the journal article itself is pretty big. That’s an extremely common phenomenon with many of the press releases I read, compared to when I check the original papers. (In this case, the press release isn’t just sensationalizing, it’s also wrong. Scientists already knew that inflammation helps to heal wounds; what’s new in the paper is the role of macrophages producing IGF-1.) But you’re actually touching on the fundamental challenge in reporting on science and health — the idea that every story has to report a “breakthrough” rather than an incremental addition to existing knowledge. It’s not a dilemma with easy answers, unfortunately.

    In this specific case, I actually wasn’t able to find any evidence that “too much” inflammation delays long-term healing of soft-tissue injuries (aside from “intuitive” or anecdotal explanations). I’d definitely be interested in hearing from anyone who can explain how that works, or point me in the direction of relevant papers.

  6. I think we’ve all lost track of the fact that this was a mouse study. Animal models, although good for hypothesis generation, are not equivalent to human trials. Not only that, but these mice were CCR2 knockouts, not healthy humans who take occasional anti-inflammatories when injured. If anything, it demonstrates that CCR2 is necessary for proper healing in mice, rather than inflammation being required for athletes to heal.

  7. @thedocsquawk
    To clarify, what the mouse study demonstrates is that macrophages are the primary source of IGF-1. It’s a mechanistic study.

    The link between anti-inflammatories and delayed healing of ligament, muscle, tendon and bone in humans has been established clinically for years. Stuart Warden’s article in BJSM last year summarizes some of the findings and references the original papers.

    Having said all that, no one is recommending that healthy humans shouldn’t take “occasional anti-inflammatories when injured” (or at least, I’m not). But a lot people, especially athletes, take NSAIDs on a regular basis to cope with the wear and tear of training at a high level. These people should be aware that there are trade-offs with that decision — that rapid recovery may come at the expense of longer-term adaption.

    Even at a recreational level, understanding that inflammation isn’t a “pure evil” — i.e. that it has beneficial effects — should encourage people to err on the side of undertreating rather than overtreating minor injuries. On the other hand, if someone reads this article and says “Aha! I’m never taking anti-inflammatories again!”, then they haven’t understood the article.

  8. I have twised my knee i think and i am waiting for a MRI scan, but my knee is reallly swollen, should I ice it or leave it because i thought once you ice it, it leaves the veins small making your recovery slower

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