As a follow-up to “Are golfers wasting their time icing injuries?” I had a chance to speak with Gary Reinl, author of Iced! The Illusionary Treatment Option about what golfers ought to do instead of, well wasting their time icing injuries.
Reinl has spent more than 40 years in sports medicine and has done everything from train professional athletes, to develop strength-training programs for pregnant women, to orchestrate rehabilitation programs for injured workers.
With the publication of Iced!, Reinl pointed out the erroneous nature of some popular assumptions about injury and treatment and suggested a different way forward, so he seemed like a natural point of contact.
My questions, below.
Strains and pulled muscles are common for golfers. Is there any place for icing in the treatment of these routine golf injuries?
No. Unless of course you want to delay healing, increase swelling, cause additional damage, shut of the signals that alert you to harmful movement and provide false hope (make yourself believe that you are doing something good when in fact you are doing the opposite).
Hitting out of a gnarly lie in the deep rough, you badly hurt your wrist. You know you can’t continue playing, so you head back to the clubhouse. Someone fetches you a bag of ice. What do you do next?
Politely thank them and tell them that you are going to get a professional medical evaluation before you initiate treatment (until you confirm the extent of the problem, “friendly” advice is often counterproductive and almost always ill-advised).
That said, once your doctor has given you the green light to begin facilitating the healing process via muscle activation, follow this basic rule: “Use your brain, never cause pain.” If anything beyond lightly wiggling your fingers causes pain, limit activation to finger wiggling. This is not a contest or game. Think: “No pain, all gain.”
If your doctor has written an order for you to use an FDA-cleared muscle activation device, use it as directed (several hours per day for the first couple of days is pretty standard). Regardless of how you activate your muscles, never forget that healing is contingent upon muscle activation not absolute stillness.
You’ve just walked 36 holes. You drive home and your legs are screaming. What’s the best way to deal with the situation, instead of reaching for the ice pack?
Since the “ice pack” actually makes things worse, doing nothing is better than icing.
What’s best? Lightly activate the muscles that are tired and or sore. Muscle activation or “active recovery” is not only the best way to facilitate the healing process, it is, in essence, the key to tissue regeneration. Absolute stillness is the proverbial enemy.
What are the adverse effects of icing on golf-related injuries, generally speaking?
Icing damaged tissue delays healing, increases swelling, causes additional damage, shuts of the signals that alert you to harmful movement and makes you believe that you are doing something good, when in fact you are doing the opposite. Additionally, when you fail to optimally heal, you risk dampening your golf skills and setting yourself up for further injury.
How did we get to the point where reducing swelling and inflammation via icing are seen as good things?
First of all, icing damaged tissue does not reduce swelling or inflammation. Delay it? Yes. Increase it? Yes. Reduce it? No.
How did the medical community get it so wrong?
It all started back in 1962 when a doctor named Ronald Malt reattached the severed limb of a 12-year-old boy named Everett Knowles. Since this was the first operation of its kind, it made big news around the world. When asked by reporters, “What’s the best way to protect the severed body part while transporting it to the hospital?” The doctor responded something like this: “Keep it out of the sun, keep it cool, and put it on ice if possible.”
Over the years, the public converted the doctor’s very specific recommendation that applied only to severed body parts to “put ice on any damaged tissue,” and the myth took hold: The “ice age” was born.
Interestingly, the godfather of the ice age, Gabe Mirkin, MD, recently recanted his decades-old recommendation and now says that icing damaged tissues delays healing.
Are there any times a golfer should consider using ice?
Yes! No one likes a warm margarita. Cheers!