Ice Age: Rethinking Icing Injuries and Sore Muscles

I remember when I went to the nurse in high school for a medley of ailments, and it seemed like no matter what the symptom was, a pack of ice was the associated prescription. Headache? Put ice on it. Muscle pain? Put ice on it. The building was on fire? Throw ice on it. Okay, the last one was a pretty lame joke, but somehow ice became a panacea in my nurse's eyes. It seems that in the sport and exercise world, such is also the case.

Ice Baths for Recovery

I just started watching Game of Thrones,
and I couldn't resist using this meme...

The most common use of ice that I hear people tout is its recovery healing powers. Are torturous ice baths as effective as we make them out to be?

We have evidence of the early Egyptians using early forms of cryotherapy in 2,500 BCE to treat a medley of ailments. Fast forward to 2018 and you see people immersing themselves into futuristic-looking cryotherapy chambers filled with liquid nitrogen. As you can imagine, extensive research on the subject has been done since ancient Egyptian times.

Now, one study done by Fonda and Sarabon (2013) did find that participants who utilized whole body cryotherapy reported feeling less sore than those with no intervention. While this is more qualitative rather than quantitative evidence, it does show the potential for a decrease in the perception of DOMS with cold immersion.

Hausswirth et. al. tested runners and also found a reduction in pain and subjective fatigue 24 and 48 hours after their runs in participants using cryotherapy chambers. While this is also a qualitative measurement, researchers also found an increase in strength when compared with the control group (2011).

Contrarily, Costello et. al. measured MVC (maximal voluntary contraction of a muscle) 24 hours after an eccentric exercise protocol and found no significant differences in muscle soreness in participants who were immersed in -110° C temperatures and those who weren't immersed (2012). 

Overall, the current body of research does seem to suggest that cold immersion can help reduce subjective measurements of fatigue and soreness in athletic populations, but the verdict is still mixed as far as I'm concerned. Many of the measurable, physiological markers of recovery were unchanged, but the participants simply reported feeling better. My thought process is that a lot of the attributed markers of recovery are due to a placebo effect. Effectively, if you feel like an ice bath helps you feel like you're being active in the recovery process, then keep on as you were. It may not be efficacious, but it's worth a try!

Ice Baths for Treating Injury

Going back to my high school nurse who would use ice as a cure-all, many people still assume that icing is the best protocol for soft tissue injuries. Let me start by saying that ice works as an anti-inflammatory and also a vasoconstrictor (meaning your blood vessels constrict). The downside here, is that we societally regard inflammation as a negative thing, when it is in fact your body's line of defense. Inflammation is necessary to jumpstart the healing process. The more blood flow you get to an area, the quicker the repairing process can start. Gary Reinl, author of the book "Iced" which covers this topic more in-depth, notes "the inflammatory cells remove debris and recruit cytokines and other growth factors toward the injury site." As such, swelling and inflammation are not symptoms to fear or reduce in this case. He goes on to say, "In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase. The fibroblasts build a new extracellular matrix and persist into the final phase of repair, the maturation phase, where, if all goes well, functional tissue is laid down. The key point is that each phase of repair is necessary for the subsequent phase."

Additionally, the University of Pittsburgh Medical Center (my alma mater) noted that "…ice may not be the best treatment for aching muscles — in fact, it could even be detrimental to recovery" (2011). The British Journal of Medicine reached a similar conclusion, stating that "ice is commonly used after acute muscle strains but there are no clinical studies of its effectiveness" (2012).

Summing it All Up

Icing injuries has become a staple in workout and recovery protocols for people all across the globe for ages. As it turns out, the effectiveness as icing for both decreasing muscle soreness/damage and for aiding in the healing process of an injury seems to be unfounded. The body of research denouncing the usage of ice on both accounts seems to outweigh the papers that support its application.

I personally don't use ice in either instance, and I believe that rest, sleep and proper nutrition can be some of the most effective recovery strategies! Next time you go to jump into the ice bath or wrap an injury in a bag of ice, ask yourself why, and decide whether or not it's actually going to help you or potentially hinder you.

Fixing 5 Flaws in Your Running Form

If you're like me, just hearing the word "run" makes your skin crawl. Some people claim to find peace of mind on their daily jog. Are these people crazy, or have they just found some sacred running nirvana-type state? Well, if you work on your running technique, you will undoubtedly find that you will improve all of your times, and the whole process just might be a little bit less arduous!

Like a power clean or a deadlift, there a lot of technical nuances involved when sprinting or distance running. The fastest and most efficient runners are experts in perfecting their stride length, stride frequency, heart rate, and breathing patterns. All of these things work together to help you channel your inner Tyson Gay. Here are five of, what I deem to be, the most common technical errors in gait:

1. You're striking with your heels first. Try something for me: jump up in the air, and then deliberately land on your heels first, rather than on your toes. How did that feel? Presumably, pretty awful. In one of my previous posts, I touched upon jumping mechanics. The author of Running Science, Owen Anderson notes, "...motion analysis of Olympic Games competitors has suggested that ... medalists are more likely to employ MFS (midfoot strike). In addition, video analysis of world-champion and world-record holding runners ... has indicated that such competitors employ MFS, and occasionally FFS (forefoot strike), but not RFS (rearfoot strike) while training and competing." It has been theorized that a RFS can place more stress on the knee joint and simultaneously increase breaking forces, which may decrease running economy. There appears to be a correlation between race times and MFS/FFS.
2. You're leaning too far forward. As with standing posture, you're trying to maintain a nice vertical torso, and make yourself "tall." This means you shouldn't be hunched over like Quasimodo and looking at the pavement. While that may be ever-so-tempting once you get fatigued, you'll be more efficient staying upright. Worldrunning.com mentions that "[if] you have bad posture then your body will have to use up energy to keep you upright, which wastes energy you should be using to run faster and further."
3. You're not moving your arms enough. Now, let me start by saying that you don't want to go overboard with arm movement, either. Ideally, it should be a relatively passive motion. Pumping your arms like crazy isn't necessarily going to make you a speed demon. On the other hand, I've seen some people who leave their arms to flop limp at their sides, which is equally as inefficient. The arms should be moving in sync with the legs (the left leg and right arm together, and the right leg and left arm together), allowing for a little bit of rotation in the hips. "The main function of your arms is not to drive the body forward but to provide balance and equilibrium as gravity pulls you forward," notes Dr. Nicholas Romanov, the founder of the Pose Method of running.
4. Your knees are collapsing as you run. Running is a forward, linear movement, performed predominantly in the sagittal plane. Any forces that counteract that are going to result in unnecessary energy expenditure. Knees caving inward (valgus knees) are usually coupled with external rotation of the feet. Take a look at the the photo below of the sprinters. The two sprinters on the left are maintaining forward momentum, while the gentleman on the right has some internal rotation of the hip, as his foot externally rotates. With a little bit of hip strengthening, he could shave some seconds off of his split and lower his risk for injury.
5. You're breathing incorrectly. Breathing in any activity is, to me, the most important determining factor of success. In an aerobic activity like a longer distance run, breathing should be a first priority. As you fatigue, you may have noticed that your breath becomes shorter and more rapid. Maybe you start wheezing like an asthmatic, and you're doing anything you can just to finish your run. Experienced runners, however, have mastered the rhythm of their breathing. While different coaches have numerous methods for the proper cadence of the breath, there are some aspects that are universal: you should aim to expand the ribcage and the belly as you breathe, rather than just the chest, and, your breath should remain relaxed rather than laborious. Both of these things can help you manage your heart rate and keep you running faster for a longer period of time!

Running doesn't have to be a miserable experience (although it'll never be a pastime I particularly enjoy...). If you correct your technique, you will minimize the amount of energy you waste with each stride, and maybe, just maybe, you'll find that elusive "runner's high" I've heard people mention in fables.

Crossing Over to Better Movement Patterns

Have you ever watched a sprinter running and wondered why the heck he’s pumping his arms back and forth like a windmill? Running is all about the legs, right? Wrong!

When we walk or run, we intuitively synchronize movement of contralateral (opposite) sides of our bodies. This means that as your right leg steps forward, your left arm automatically reaches forward with it, allowing for more energy-efficient movement, and preventing excessive rotation of the trunk. In fact, a study at the University of Michigan found that we expend up to 12% more energy (calories) when we don’t use our arms. [1] For someone who’s trying to shave .01 seconds off of his 40 yard time, this is definitely not ideal. When the body moves as one chain, as it was designed, we can move effortlessly and fluidly.

Unfortunately, many people in this desk-jockey age have forgotten how to move freely without first smashing a lacrosse ball into every tight spot they can find. Simple tasks like walking to the mailbox or going for a jog become arduous and bring about lower back pain and shin splints. Adding cross crawls into your program will help you regain mobility and may even reduce your risk for injury. [5]

Cross crawling patterns are an excellent way to retrain your body to synchronize the right and left sides seamlessly. When we were toddlers, crawling was the only way we can move from place to place. Slowly, our nervous systems built new patterns, as we better understood how to navigate our centers of mass and coordinate the right and left sides of our developing bodies. Now, you can use the same tools you used as a child to reset your nervous system and retrain yourself to move.

One example of a cross crawl, and one of the most basic regressions, is a march or a skip. You’d be surprised by the number of people get confused when I initially show them how to skip. I’m willing to bet you haven’t skipped in quite a few years! Skipping is a wonderful way to awaken the nervous system and prime your body for more complex movements. Marching can be done stationary or while moving, but I usually instruct my clients to move as slowly as possible. You want to bring one knee to your chest while the opposite arm reaches up towards the sky.

Remember, this is not a race to the finish line! The purpose of these exercises is to teach control, so it is important to make sure you execute them while focusing on stabilization, synchronization of the movement, and breathing. Usually 30-50 repetitions at a time is sufficient. You can do them throughout the day, or choose to superset them with other exercises in your routine.

From there, the next progression would be some type of quadrupedal crawl. This includes military crawls (imagine a soldier crawling through the mud), baby crawls (yep, just as your child would), and bear crawls. If you’re looking to raise some eyebrows at the gym, these are especially fun. Personally, I love bear crawls, because the athlete learns how to functionally activate his core and stabilize his shoulders and hips, all while improving his posture and mobility. I know, it almost sounds too good to be true! Believe me though, you’ll feel like a million bucks afterwards, and you’ll get a great sweat in the process. For an extra challenge, try doing backwards bear crawls.

Again, just like with the marching, you should move very slowly and carefully during these movements. Many of my clients (especially children) are inclined to try to race across the gym floor on all fours. While I appreciate their competitive spirits, it is actually far more difficult to dial down the pace and pay close attention to your positioning. To prevent your spine from rotating too much, you might find it helpful to place a book or a yoga block on your back while you crawl.

The last variants of the cross crawl are stationary as well. These movements include the bird dog and the deadbug (I promise, I didn’t come up with these names). The bird dog is very similar to a bear crawl in that you need to really activate the shoulder girdle to stabilize yourself. As one arm comes forward, the opposite leg reaches out behind you. About 10 reps on each side is enough.

On the deadbug, you will place both hands on the wall and reach your legs out in front of you, bringing one leg up while you lower the other towards the floor (again, slowly). The key here is to make sure you’re using your abdominal muscles and not your hip flexors. Try to continue breathing diaphragmatically throughout the entire movement. I have my clients perform this movement for as long as they can with control. Once I see them start to shake or compensate, I have them stop. 20-30 seconds at a time should be fine to start.

The great thing (well, one of many great things) about any of these cross crawl variations, is that you can utilize them everyday. Bear crawls are an excellent rest day exercise. While this is anecdotal evidence, the benefits these movements have given both me and my clients has been incredible. I personally aim to crawl for around 5-10 minutes per day, both forwards and backwards! I’ve found that crawling loosens up my hips and alleviates tightness in my lower back.

The more you do these movements, the greater the rewards. I believe that a strong core is the key to success in any sport. In my opinion, movements like crunches are a waste of time; how much will your sit-ups carryover into other movements like jogs or split jerks? Not very much. Instead, I’d rather teach my clients to use their cores as they were meant to use them: to stabilize the pelvis and the shoulders. These cross crawl movements are the best method I’ve found to achieve that.

If you have children, try to mimic the way they move. Kids don’t need to foam roll their quads and their glutes before they squat--they just do it naturally! They are constantly moving, and they’re not sitting at work in front of a computer for 8 hours at-a-time. We could stand to learn a few things from kids!

Work Your Weaknesses

Weaknesses--we all have them.  Unfortunately, no one can be an athletic superhero who excels at everything. Everyone has one thing (or multiple things) that gives them knots in their stomachs just thinking about it. For me, it's rowing or running.

Whatever that "thing" may be for you, the worst thing you can possibly do is avoid it. For years in high school, I tried to get out of running the mile because I hated it that much. You know what? I never became a better runner, until now. I do not proclaim to be on the same level as an Olympic sprinter, but I'm certainly miles better (no pun intended) than I was in high school. Now I force myself to do maximum effort sprints at least 1-2 times a week. Yes, there are many times I want to keel over in the midst of it, but I don't--I just suck up my pride and get it done.

There was a very long period of time when I was unable to do double unders (two revolutions of the jump rope for every one jump). Everyday, I practiced and came out of the gym with bruises and whip marks all alone my arms and legs. I may have looked ridiculous, but guess what? Despite all of my welts, I kept on trying. Today, I can finally perform multiple consecutive double unders with relative ease, and I will only continue to progress.

My point is this: in order to truly see progress, you have to force yourself to do what inspires terror within you. If you've never been able to do a pull-up in your life, practice pull-ups every damn day until you get one. Start with a band and focus on the lowering phase. Do whatever it takes to make your weaknesses into your strengths. No change comes without dedication and practice.

I leave you with this wonderful quote from Robert Louis Stevenson:

"You cannot run away from weakness; you must some time fight it out or perish; and if that be so, why not now, and where you stand?"