Sciatica? To Ice or Not to Ice — That Is the Question

About a year ago, I developed an instructional video lesson on the application of ice massage for various musculoskeletal pain disorders, including—but not limited to—cases of nerve impingement. Over many years of writing educational materials and creating video lessons, I have not always been 100% satisfied with the final results. Sometimes, after the fact, I would think, I should have added more… clarified better…

But this ice massage video was different. One year later, I still feel proud of it. I believe I created an extremely important and valuable resource. Why so important? Because when we aim to prevent spinal and joint surgeries through therapeutic intervention, ice massage—when applied correctly—plays a crucial role.

For better understanding and analysis, I highly recommend that you read my article before continuing with this post: My New Master Class

Back to “To Ice or Not to Ice”

Since the release of my ice massage video class, many massage therapists—and even laypeople—have learned this easy-to-perform yet highly effective technique. The feedback has been overwhelmingly positive, with many reporting excellent clinical results.

I believe in a simple and practical clinical approach—science-based, yes, but without “academic complications.” Too often, the academic language used in educational materials leads massage therapists to pretend they understand, even when they don't. And yet, true understanding is crucial to producing good therapeutic outcomes.

Everything I teach is rooted in the science of massage—a specialized, clinical application of biomedical knowledge. It's not vague theory but direct, hands-on practice that delivers measurable results.

A Question Sparked by a Student

This article was inspired by a Facebook post from one of my students. She wrote:

“What is your opinion about this article? I watched Boris Prilutsky’s video class and was impressed with the results I got using ice massage. What do you think?”

She shared this link: Warming Up to Therapy Options Other Than Ice

Her question was sincere, but it revealed a common problem—confusion caused by non-clinical, non-massage-related articles, often written by people who have no hands-on experience with medical massage.

Unfortunately, many believe that if something is published in a so-called "scientific" journal and references a doctor’s name, it must be true. That’s indoctrination, not education.

This article was written by someone who is not a massage therapist. Why should it be considered relevant? Massage is about results—nothing more, nothing less. If a therapist is achieving safe, consistent, and lasting improvements using ice massage, and a Harvard professor says it's wrong—should that therapist abandon their results? Confidence increasing our own energy status, much-needed for successful outcome of massage procedure.

Clinical Thinking vs. Academic Titles

In the mentioned Facebook discussion, to my great surprise and disappointment, a post appeared from a very experienced medical massage practitioner and educator with a strong academic background. In my opinion, he was blinded by the title: “Sports Medicine Dr. Mirkin from Harvard University.”. Although he admitted “It poisoned generations of DC, PT, and MT. Finally, the tide is changing and Dr. Mirkin himself is the most compelling evidence of it”

The main question is no matter how wrong or perfect work of sports medicine medicine Dr. Mirkin from Harvard University, for God sake how it related to program I am teaching ?and/or to massage procedure ? How it related to original post and question of my student? Here is what he posted, including link to Dr. Mirkin confession.

“Clinical application of ice: 1. 24-48 h after acute trauma 2. Initial temporary application in cases of severe peripheral neuralgia to control burning pain 3. Acute inflammation, for example, rheumatoid arthritis, gout etc. 4. Ice application of ice bath after strenuous exercises but only 2 hours after it ended. 40 years ago, sports medicine Dr. Mirkin from Harvard University developed the widely accepted treatment option for soft tissue pain and dysfunction, which he called RISE: rest, ice, compression, elevation. It poisoned generations of DC, PT, and MT. Finally, the tide is changing and Dr. Mirkin himself is the most compelling evidence of it. In 2015, he publically acknowledged his mistake in recommending ice therapy as a tool to treat soft tissue injuries and dysfunctions. Finally, things are in the correct order.

https://drmirkin.com/fitness/why-ice-delays-recovery.html

My question was and is, how all of what was said related to my teaching of specific methodology application of ice massage? It isn’t.

One of my students, Kalion—who has a very analytical mind—responded insightfully, pointing out that the article was unrelated to ice massage as I teach it. Different methodology. Different clinical purpose. Different context.

As massage therapists, we are independent first-order providers. We must be capable of critical clinical thinking rooted in the specifics of massage therapy—not swayed by unrelated opinions or titles.

Clarifying the Science

Before analyzing Dr. Mirkin’s “confession,” let me offer some conclusions.

It's easy to get confused unless we understand that massage science is different from general biomedical science. It's a specialized clinical science tailored to hands-on therapeutic work.

If you haven’t read it yet, please take time to explore my article: ???? Biomedical Science vs. the Science of Massage

Now, back to the Dr. Mirkin’s “ claim:

“Anything that reduces inflammation also delays healing.”

If that’s true, then logically, orthopedic surgeons, neurologists, rheumatologists, and primary care doctors should stop prescribing steroids, NSAIDs, and corticosteroid injections. These are all anti-inflammatory interventions. Should they be banned because they “delay healing”? We know about overprescribing steroids packs, we know about many time unnecessary hydrocortisone injections implemented randomly. We know about massive consumptions of non-steroid over-the-counter medications. This mentioned above phenomena have to be stopped but not be banned.

The Role of Inflammation and Ice Massage

Dr. Mirkin writes:

“Healing requires inflammation.”

True—but it’s not that simple.

Let’s talk about muscle soreness from intense exercise. These immune cells can help clean up tissue, but when over-activated, they can also damage healthy muscle fibers.

This is why we begin post-event sports massage 2 hours after intense activity—to normalize neutrophil migration and levels, prevent excessive phagocytosis, and protect healthy tissue.

This is often the case at sprain-strain trauma, involving excessive neutrophil migration . Massage procedure preventing this possible damages by inflammatory respond.

Ice Massage: Clinical Value

Let’s be clear: ice massage is not the same as applying a cold pack.

The brain dislikes localized cooling and responds by increasing blood flow to the area, restoring temperature. The critical point is ice massage addressing specific localized areas , like nerves /muscles junctions , absolutely different then application of cold packs.So, after a brief ice massage application, patients often report a sensation of heat. This is not a coincidence—it’s the result of a neurovascular response, leading to increased blood supply and faster healing. Yes clinically proven, correctly applied ice massage, dramatically increasing speed of the healing process,

Massage therapists must understand that our science is unique. It’s not general medicine. It’s not physical therapy. And it’s certainly not athletic coaching. It is clinical massage therapy, based on decades of applied research, hands-on outcomes, and physiological and pathophysiological understanding.

Final Thoughts

Post-traumatic response includes inflammation, lymphedema, and muscle spasm—all of which are linked to inadequate blood supply. Massage, through lymphatic drainage, venous return enhancement, muscle relaxation, and targeted techniques like ice massage, works to restore sufficient blood flow.

And that, dear readers, is the foundation of healing.

Ice massage—when applied properly—stimulates blood flow, not delays healing. It is a powerful, scientifically sound, and clinically proven tool in the hands of a skilled therapist.

Please feel free to share your questions, thoughts, or disagreements.

Best wishes,
Boris Prilutsky