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Kelly talks about how he and his team don’t like to ice because it stops the natural healing process by reducing blood flow. In my opinion, however, wearing a compression wrap also reduces blood flow, thereby theoretically also stopping the natural healing process. Compression raises the pressure of the compartment, which decreases the pressure gradient (Pi-Pf) for blood flow. This reduction in the outflow of blood decreases overall perfusion to the area. Things get backed up. Indeed, compression would prevent further congestion from building up, but this would be no different than ice.
He also talks about how icing disconnects the body part from the brain. But can this be a good thing for an injured/painful tissue? I wonder if decreasing the pain stimulus prevents the brain from introducing negative compensatory movement patterns…
Is compression more beneficial in the fact that it provides mechanical support to the tissues?
Would love to here some thoughts on this. Especially yours, Kelly!
Dr. Usama Siddique
Love your thoughtful questions. The issue with icing is that it delays/attenuates healing. Period. It also has been shown to make the lymphatics porous, re-introducing sequestered waste material back into the interstitial tissues. The lymphatics are the sewers. They move upwards of 3 liters of lymph/day. Are we measuring tissue temps post/peri ice? Is there any evidence to support laying around and not introducing graded motion and making the tissues cold? No there is not. If we have uncontrolled pain, perhaps one bout of icing would work until…the tissue warmed back up 10-20 min later? And now, we have more congested tissues and perhaps an increase in perceived pain as the brain in now flooded with the temporarily blocked tissue signaling.
The compression will keep tissues from swelling (like a pro-fore boot) for lymphedema, tight compression limits fluids out potentially (like a tight sock). But high level temporary compression does makes sense by not limiting the plumbing. Supporting a tissue mechanically can help for sure, but it has to be balanced with the tissue fluid dynamics. ART not science.
Thanks again for your thougtfulness!
Love the answer! Thanks so much!
Also! New article summarizing research in the New York Times suggesting that icing greatly delays/retards muscle healing in rats!