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Ice Delays Recovery from Injuries

More than 30 years ago I coined the term RICE (Rest, Ice, Compression, Elevation) for the acute treatment of athletic injuries. Now a study from the Cleveland Clinic shows that one of these recommendations, applying ice to reduce swelling, actually delays healing by preventing the body from releasing IGF-1 (Insulin-like Growth Factor-1), a hormone that helps heal damaged tissue (Federation of American Societies for Experimental Biology, November 2010).

When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Certain cells called macrophages rush to the damaged tissue to release IGF-1 which helps heal muscles.

Healing is delayed by cortisone-type drugs, nonsteroidal anti inflammatory drugs such as ibuprofen, applying cold packs or ice, and anything else that blocks the immune response to injury. Now the treatments for an acute injury include Rest (stop exercising), Compression and Elevation (to reduce swelling), but no ice.


Dear Dr. Mirkin: How does air temperature affect training?

A paper from the University of Oregon shows that training in the heat can improve racing performance in the cold (Journal of Applied Physiology, October 2010). Twenty competitive cyclists continued their regular training. In addition, they completed ten 1.5-hour training sessions at 50 percent of their maximum effort (VO2max). However one group rode in a lab heated to 104 degrees, the other group rode in 55 degree lab.

The cyclists who were heat acclimated improved their time-trial performance four to eight percent, while the cold-trained group did not improve.

Training in the heat makes you a better athlete because it cools your body better. Since more than 70 percent of the energy used to drive your muscles is lost as heat, the harder you exercise, the more heat you generate and your body temperature rises. With each increase in body temperature, your body requires more oxygen to turn food to energy. Since lack of oxygen is the limiting factor to how fast you move and how much power your muscles generate, any increase in body temperature slows you down.

Training in the heat increases blood volume so you have more blood available to carry heat from hot muscles to your skin where the heat can be dissipated. sweating begins earlier and is more profuse to cool your skin, and the heart pumps hot blood to the skin faster. All these factors lower body temperature.

Some athletes may decide to heat train by wearing plastic or thermal suits. It could be dangerous because it prevents sweat from evaporating and a person could overheat and pass out or even die. You can help protect yourself from heat stroke by knowing the progressive signs of rising body temperature. See last week's issue on the dangers of swimming in warm water:


Reports from

Increasing stride length
Efficiency in running form
Measuring calories


Dear Dr. Mirkin: Will taking drinks that contain protein and sugar help me to exercise longer and recover faster than drinks that contain only sugar?

Probably not. Researchers at the University of Birmingham UK showed that, compared to drinks that contain only sugar, those that contain sugar and protein do not increase power output, improve cycling performance, or hasten recovery from hard exercise (Medicine & Science in Sports & Exercise, June 2010).

However, taking sugar and protein from any source within an hour after you finish exercising can help you recover faster. Extreme muscle sensitivity to insulin caused by exercise lasts about an hour after you finish exercising. The carbohydrates call out insulin and insulin drives amino acids into muscles to hasten recovery.

Some previous studies showed that sugar-protein drinks improve athletic performance. However, they used beverages containing far more calories than the sugar-only drinks that were used as controls. Thus the improved performance probably came from the extra calories, rather than from the protein itself.


Recipe of the Week:

Split Pea and Barley Stew

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

June 21st, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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