Ice, does it really help post-exercise recovery?

    I’m sure everyone has heard that putting ice on an injury or taking an ice bath after a tough work out helps with recovery. But what is the physiological evidence behind this theory?

    Recently, studies show that whole body cryotherapy (WBC), or full body icing helps to improve pain by 80% (Rose, et. al, 2017). But, the literature remains inconsistent in supporting WBC as the most useful treatment for recovery as there is insufficient evidence on other benefits and only limited evidence that WBC reduces delayed onset muscle soreness (Leal-Junior, 2015). A review of five studies comparing photobiomodulation (PBMT) and cryotherapy support that photobiomodulation is more effective for post-exercise muscle recovery following exercise (Fischer, Rigby, Mettler, McCurdy, 2019). Photobiomodulation is a low-level laser light therapy (Hamblin, 2016). Photobiomodulation has increased ability to reduce creatine kinase, inflammation markers, and blood lactate compared to cryotherapy following intensive exercise (Fischer, Rigby, Mettler, McCurdy, 2019). In comparison to cryotherapy, studies also demonstrate that photobiomodulation improves muscle performance and function following an intensive work-out (Fischer, Rigby, Mettler, McCurdy, 2019). Additionally, photobiomodulation therapy lead to enhancement of outcomes of strength training workouts like increasing muscle thickness when applied before the workout (Leal-Junior, 2015). Other studies demonstrate that PBMT may be beneficial for hearing loss, it may enhance radiotherapy treatment of cancer cells, it could reduce skin fibrosis, and increase resistance to fungal infections (Hamblin, 2016). Why should we continue to use ice as a recovery tool post-exercise if PBMT has more conclusive research? 

    In terms of biomedical ethics, I think it is important to further research PBMT before implementing it as the standard post-exercise recovery treatment. With any new type of treatment, there are risks involved; these risks can only be identified through further testing. In order to do good, beneficence, it is our duty as healthcare providers to diligently perform this research in order to give our patients the ability to achieve their optimal health; and in this case, their optimal athletic performance. Since PBMT is relatively new and involves more equipment than ice, it is important to consider justice. In order for there to be fairness for all people, this treatment must be equally accessible to all if it does become the new standard for post-exercise treatment; not just available to the athletes with the privilege and ability to obtain the best treatments. 

Fisher SR, Rigby JH, Mettler JA, McCurdy KW. The Effectiveness of Photobiomodulation Therapy Versus Cryotherapy for Skeletal Muscle Recovery: A Critically Appraised Topic. J Sport Rehabil. 2019 Jul 1;28(5):526-531. doi: 10.1123/jsr.2017-0359. Epub 2019 Jan 29. PMID: 29952693.

Hamblin M. R. (2016). Photobiomodulation or low-level laser therapy. Journal of biophotonics, 9(11-12), 1122–1124. https://doi.org/10.1002/jbio.201670113

Leal-Junior E. C. (2015). Photobiomodulation therapy in skeletal muscle: from exercise performance to muscular dystrophies. Photomedicine and laser surgery, 33(2), 53–54. https://doi.org/10.1089/pho.2015.9851

Rose C, Edwards KM, Siegler J, Graham K, Caillaud C. Whole-body Cryotherapy as a Recovery Technique after Exercise: A Review of the Literature. Int J Sports Med. 2017 Dec;38(14):1049-1060. doi: 10.1055/s-0043-114861. Epub 2017 Nov 21. PMID: 29161748.