In 1978, Dr. Gabe Mirkin had sensationalized the term RICE (Rest, Ice, Compression, Elevation). He has since changed his point of view on the use of ice and compression as it relates to healing and has mentioned that it could have reverse effect, and this is largely unknown by the baseball community.
Cryotherapy, the use of cooling a body part or total body, has been extensively studied with mixed findings. In some research, benefits were found subjective without any physiologic change in markers of inflammation while others have found no benefit to cooling, nor with intermittent treatments of hot and cold, called contrast therapy.
So how did icing become a part of baseball? Many believe that it was Sandy Koufax who popularized cryotherapy, dipping his elbow in an ice bath after games. Sandy also took interviews when icing his arm, so there is plenty of evidence by the press that this was common practice for one of the greatest pitchers of all-time. The last time Sandy iced his arm was in 1966 and 54 years later, there are pitchers who still wrap their arms in ice (see our Sandy collection below).
Sandy Koufax 1955-1966
A High School Player in 2019
Athletes need to determine the difference between delayed onset muscle soreness (DOMS) and pain. If you experience soreness post-throwing, it can actually be a good thing. Inflammation actually increases growth factors that trigger satellite cells, being the cells that upregulate protein synthesis, as well as immune cells to repair muscle and make them even stronger. If you ice, you are actually blunting the onset of recovery and may cause more harm than good.
- Blood Flow In
- Blood Flow Out
- Muscle Contraction
Ice and compression fail to accomplish these requirements. Blood flow is constricted from coming in meaning less nutrition and more immune cells are following into damaged tissue sites and less byproduct of muscle damage flows out of the tissue. Think of your capillary beds being multiple hoses that are kinked as result of cryotherapy. Compression can cause further issues as it can reduce oxygen to the tissues and actually cause secondary cellular death through a condition called ischemia (oxygen starvation). Ultimately, when the arm thaws, a rush of more fluid enters the tissues further extending the inflammatory response, being the exact opposite of what one would want with the use of ice and compression.
So what should you do for post-throwing recovery if ice does not help?
Heat and muscle contraction. Heat creates dilation of blood vessels increasing blood into the muscle while muscle pumping takes fluid out of the muscle tissue through another set of vessels called lacteals. Lacteals are the primary transport unit for the lymphatic system which moves fluid that contains immune cells called lymph. The lacteals are integral to lymphatic draining of fluid in swollen areas of the body. Lacteals are not like veins where they do not have valves to prevent backflow. Instead, the muscle squeezes on the lacteals and the lacteals reabsorb the fluid when the pressure is released. Muscle pumping of lacteals through alternating contraction and relaxation has the lacteals operate like a shopvac pickup up remaining fluid and damaged cells from intense throwing bouts.
A popular machine that helps in muscle pumping is the MarcPro. The MarcPro is type of NMES machine (neuromuscular electrical stimulation unit) that causes muscles to twitch passively. This low metabolic cost of muscle contraction is a perfect post-throwing solution to reducing soreness caused by built up pressure from fluid inside the tissues. NMES should be performed after an active bout of muscle pumping to promote angiogenesis (blood vessel growth) through rhythmic activity such as the use of the body blade or shoulder sphere.
Lastly, an important finding often overlooked in the famous Olsen et al. study, indicating that fatigue caused 36x risk of injury to pitchers, was that injured pitchers used NSAIDs (Non-steroidal anti-inflammatory drugs) and iced more than healthy pitchers.
Before you reach for the icebag and an Advil tablet, consider other alternatives and get your mind around local inflammation in being GOOD for the throwing arm. If you find yourself experiencing soreness that does not reduce with muscle pumping and heat after 48 hours, you may want to consult a medical professional. Remember in all instances, if you have pain when throwing, STOP AND COMMUNICATE WITH A PARENT OR COACH and focus on recovery methods including diet, sleep and hydration.