Icing after you throw is what is making your arm hurt. Many trainers, coaches, and even doctors are still advocating the RICE (Rest, Ice, Compress, Elevate) protocol to baseball and softball athletes. This blog will look at how research is showing that icing will delay and inhibit recovery, why this method came into practice, and better alternatives to recover after throwing.
Why have we always been told to ice?
Icing first gained traction in the sports world when LA Dodgers pitcher Sandy Koufax was pictured in a 1965 edition of Sports Illustrated holding his arm in a tub of ice. Before this even, in 1962, a boy by the name of Everett Knowles had his severed arm successfully reattached to his body. This was the first surgery of its kind and was highly publicized. When asked how it was done doctors responded that they kept the limb out of the sun and kept it cool –on ice- and over time the public adopted this as put every damaged tissue on ice. In 1978 a Harvard physician by the name of Dr. Gabe Mirkin coined the term RICE. Dr. Mirkin himself has now come to disagree with his own coined term saying icing can do more harm than good. Pretty profound statement from the man that made up a whole icing protocol.
How is icing doing more harm than good?
Inflammation is an important part of the healing process to muscles and other tissues. Inflammation is due to vasodilation and an increase in macrophages in the muscle or tissue. Macrophages release insulin-like growth factor, or IGF-1. IGF-1 will help to stimulate systemic skeletal muscle growth as well as helping to regulate DNA synthesis within the cells. These macrophages can also act as a sort of clean up crew by being able to digest cellular debris.
When ice is applied to areas of acute trauma, the healing process is slowed due to the constriction of blood vessels. When the blood vessels are constricted then it is harder for blood and nutrients to flood into the area. Even once the ice comes off, the blood vessels can remain constricted for up to several hours and in extreme cases can lead to death of otherwise healthy tissue. Icing can also wreak havoc on the lymphatic system. Prolonged icing can cause the backflow of fluid through the lymphatic vessels into the interstitial fluid (space in between cells) which will lead to even more unnecessary swelling.
Lastly, icing can lead to decreased strength and muscle growth due to the slowing down or stunting of cell activity. Through the course of a season, players will already lose internal shoulder strength due to the constant concentric action of the front of the shoulder while throwing.
What are better alternatives to icing post-throwing?
DO NOT RUN LONG DISTANCE POST THROWING/PITCHING. This is usually done to “flush lactic acid”. This can be a whole other topic on its own, but simply put, lactic acid does not cause fatigue but actually delays it. Long slow distance running will actually train the muscles to work slower causing athletes to be less powerful.
The best alternative to icing post throwing will be a movement or isometric based protocol. Band work such as Jaeger or NPA post throwing are a great way to add movement and increase flood flow through the shoulder and arms.
End range isometric holds are also a great alternative. Isometrics are proven to increase blood flow and hormone production. Isometrics are also a great way to increase strength without the risk of even more fatigue as they do not include the muscle tearing eccentric portion of the movement.
Marc pro or other electrical stimulation devices that work at a low level frequency. The low frequency will stimulate muscle contractions that can help improve blood flow without adding fatigue to the area.
Sleep, nutrition, and hydration can all be a big secondary factor to how the body will perform as well.
Quality warm up protocols can help prep the body for the stress of throwing and allow the body to refine movement patterns before going out to throw. For more information on warm up protocols, please check out our Strike People Out: How to Protect your Arm part 1, 2, and 3 blog.
With all this said, ice can be a tool to help decrease pain, but is not a good tool to aid in recovery. And if you are experiencing pain I would recommend either seeing a doctor to see if something is physically wrong with your body and if it isn’t then get in a well-rounded athletic development program or get your mechanics looked at. Also consider other modalities that could act the same way ice will such as anti-inflammatory pills and medicines, as these will just mask the underlying issue and not allow your body to give proper feedback.
Connor Green, CSCS | CAPEC | USAW- SPL1