Book Review of Iced: An Illusionary Treatment Option by Gary Reinl
I’m certain that as a follower of modernathletichealth.com you are interested in learning of only the best information. Every sports symposium I attend (sometimes 2x / year) helps provide the latest and best information. Last year, I had the great serendipitous moment in meeting Gary Reinl. He was a vendor showing off his product, the Marc Pro muscle conditioning device. Gary pulled me over and asked me to help co-treat a doctor (acting as a patient in this case) with some unusual symptoms of tightness. We discussed at length the physiological concepts that could be the cause of these symptoms. It was after we were able to alleviate some of the severity of the symptoms that he pulled me aside to ask me, “How do you feel about ice?” I wish I could have answered, “Well when Ice tries to say hi to me I usually give it the cold shoulder,” but I can’t. Sadly I’m not that quick. However, as I answered truthfully, which is to say I use it sparingly on field and in perhaps 5% of my patients in the office, he said, “Ok, do you know why we even put ice on an injury?”
I was able to answer him by spitting back from my texts and lectures. Ice is a widely accepted primary intervention to injury often accompanied by Rest, Compression, Elevation, and Protection. Together, these items form an acronym of interventions: PRICE. Protect the limb perhaps by using a splint, Relative Rest by only moving in a non-painful range of motion, Compress to effect physical leverage or replace joint stiffness, Elevate to improve circulation and Ice to numb and reduce swelling, and. This is still an accepted policy for many organizations that perform medical services at athletic events as well as an early in-patient approach. However, it’s the “ice” part that Gary Reinl challenges in his book, “Iced: An Illusionary Treatment option.”
The book begins with an introduction to Mr. Reinl’s past achievements and accolades; Introducing him as a knowledgeable, credible source. I will admit a review of one’s achievements is often necessary in an introduction, but this introduction is 25 pages long. He makes sure to note that he is “uniquely qualified to debunk the facts” (page xi in the introduction). Normally I find a review like this to be self-indulgent and at first I felt no different. However, I will add that 50% of that introduction is truly important to read so that you can understand his compulsion to investigate the facts behind the public’s tendency to just ‘slap some ice on it.’
Chapter 1 reviews some history of the use of ice as an intervention. He clearly tells the story of how ice helped doctors in reattaching a boy’s severed arm, and how it was talked about in media across the country. He discusses how in the wake of this event, doctors were asked “What’s the best way to transports the severed body part to the hospital?” To paraphrase, the doctor would tell the interviewer to put it on ice and get to the hospital ASAP. That is what it took to turn a limb saving intervention into a (as Gary puts it) “catch-all, better than nothing approach to all things injury related.” Please remember I cannot do justice to thoroughness that Mr. Reinl put into his opus. I am simply trying to get to the meat of this athletic educational meal.
Chapter 2 discusses the way ice application found its way in medical centers across the country, in counterpoint to the authors practice where ice was a rarity. Chapter 3 poses the same question he asked me: if you apply ice, do you really know why you do it? I really liked how he brought up Dr. Semmelweis who by looking at how often infection happened with surgery, eventually suggested it was the doctor that spread disease. Today, surgeons always scrub up! Chapter 3 even compares icing to bloodletting! Bloodletting! The practice of balancing the 4 humours of the body was done by getting rid some “bad” blood! (I don’t want to give away this completely but one of this country’s founding fathers was a FAN of blood letting!) The point he was making was to check yourself; you might learn something new.
Again, my goal here is not to rob you of this great read, but to get to the point that is going to help you, while giving you the opportunity to educate yourself and hopefully inspiring you to do so. My answer to Gary when he asked me how I felt about ice included what I understood about how ice worked on a live body: it slows down nerve activity to numb the area, and constricts arterioles. I was taught that it decreases swelling, however I don’t think I have ever seen an article demonstrating that. I also can say I have never seen a sprained ankle blow up with swelling, and then shrink to normal size by applying ice.
So, the question stands: Does ice decrease swelling?
For you Modernathletichealth.com readers, I’m going to give you something to consider. Maybe you have a hose running in the garden. You pick it up and put a nice kink in that hose. The flow out of that hose can be brought down to a trickle. That’s how I would like to you think about this. Damage to a tissue causes a healing cascade in the body. The goal to bring good cells to the area, and take the waste material out. Now, guess what you are doing when you apply ice and constrict those blood vessels. Anyone? Anyone? Yup, you’re putting a big ‘ol kink in those hoses just trying to carry the waste away preventing the tissue’s ability to heal.
In other words, instead of watering your lawn with a hose, you are using a drinking straw. Consider that when you are sore after having the courage (or hubris) to add those 45 lb plates to your next deadlift.
Inflammation is there to HEAL YOUR BODY!
So, why stop that? Or even slow it down?
I may have created more questions in your head than answers, but then again, that was my goal. It’s good to question someone who poses as an authority. Take a look at their level of education and experience and read them for their intent. The next time Dr. X tells you to take ibuprofen, an over the counter anti-inflammatory medication, to help you with your knee pain, you may say, “um… doesn’t that medication kill cartilage cells?”
So let me leave you with two points. First, ice is shown to shrink small arteries called arterioles. This does not mean ice stops swelling or inflammation. It could mean, however, that it does slow healing. (Do you really want to slow your healing process?) Second, I hope I have given you a little push to read this book. I didn’t want to give away the whole book, robbing you of a fun, informative and passionate read. I’m just here to help the readers who are just trying to help themselves (achieve their athletic goals).