Ice is good for more than just keeping your favorite cocktail cold. It can have a profound effect on preventing and healing injuries. In fact, it’s been used as a healing modality (cryotherapy) for centuries and continues to be one of the main methods for reducing pain and accelerating tissue healing.
Knowing how to properly ice is very important skill set to have. This article will go over the reason for icing, benefits, physiological effects, methods, and protocols. If you’re only interested in the “how to” feel free to scroll down and skip the logic and reasoning.
Reason for Icing
After an injury the body responds to injury by trying to protect itself. This is good news…to a certain degree. The body tends to over compensate during the acute healing process and you are left with residual inflammation and edema. This extra fluid in a focal area causes an increase in pressure which can compress nerves that signal pain and decrease your functional movement. This can create a viscous cycle as decreased and compensated movements may cause further injury and prevent proper healing. Icing after an injury can help to control the edema, inflammation, and pain that results from an injury, thereby limiting the loss of function and movement. Simply stated, icing can accelerate healing.
Benefits of Ice
- It’s Cheap – a one-time fee of less than $40 can give you unlimited cryotherapy for years
- Very Easy to Use – all you have to do is apply it to the affected area and relax
- Convenient – it only requires a freezer and 10-15 minutes
What Ice Can Be Used For…
- Acute and Chronic Musckuloskeletal Injuries
- Prevention and Reduction of Delayed-Onset Muscle Soreness (DOMS)
- Inflammation and Edema Reduction
- Pain Control (increases pain threshold)
Blood Flow (Hemodynamic ) Effects
◊ Vasoconstriction of blood vessels (reduces blood flow, limits internal bleeding)
◊ Increased blood viscosity ( increased the resistance to flow)
◊ Reduction in the circulatory rate
◊ Reduces the chemical reactions and vascular permeability that occur during acute inflammatory response
Ice can help control and limit the inflammation process through the circulatory system. Reducing the amount of blood to the area will lead to a decrease in the amount of residual inflammation and edema.
◊ Decreased Nerve Conduction Velocity (sensory and motor)
◊ A-Delta fibers (pain transmitting fibers) have demonstrated the greatest decrease in conduction velocity in response to cooling
◊ Increased Pain Threshold (decreased pain sensation)
◊ Reduction of muscle spasm (via the gate control mechanism)
Ice can help to reduce the body’s ability to send pain signals to the brain and thereby having an analgesic effect. Since muscles require a signal from the nervous system to contract, a decrease in conduction velocity can lead to a reduction of a muscle spasm.
Proper Icing Protocol
When to Ice
◊ After an acute injury
◊ Throughout a chronic injury
◊ After any activity that aggravates the musculoskeletal system
Use your hands. If the tissue has an increased local temperature, there is most likely an acute inflammatory process occurring and ice would have a great benefit on the healing process.
Where to Apply
◊ Depends on the type of injury and tissues involved.
◊ For Joint Injuries – put the joint in a comfortable relaxed position, wrap the ice pack around the entire joint (360° coverage)
◊ For Muscle Injuries – place the muscle in a gentle stretch, wrap the ice on top of the location where it hurts
◊ 10-15 minutes
After 15 minutes the smooth muscle of the blood vessels becomes “fatigued” and loses their vasoconstriction abilities. This could negate the beneficial effects of cryotherapy.
In the acute stage it’s important to ice as often as possible. I usually tell patients to try to aim for at least 3 icing sessions a day, even if it means bringing an ice pack to work. But make sure you wait an hour in-between icing session to allow the tissue to return to normal temperature.
It’s important to stay consistent with icing. Don’t give up after one day of icing an injury. Make sure you keep icing on a daily basis until all the pain and inflammation is gone.
◊ Try to use RICE protocols when you can
◊ Take advantage of gravity with elevation and use compression when possible
◊ As mentioned early, put joints in a comfortable position, put muscles on a gentle stretch
How to Ice: Methods
Ice Cup Massage
- Fill paper/styrofoam cup with water and freeze (don’t fill to top, leave some room)
- Tear top layer off cup
- Use small circular movements over the affected area
- Apply for 5-10 minutes or until you experience analgesia/numbness
- Best for small areas (lateral knee, plantar fascia, tennis elbow, etc.)
Ice Pack (Gel)
- Gel packs can conform to the effected area and provide 360° coverage
- Apply for 10-15 minutes
- For best results apply with RICE protocol (Rest, Ice, Compression, Elevation)
What to Expect
Ice isn’t the most pleasant modality. For this reason, many people often make the mistake of choosing heat instead. Heat is not good for acute injuries and can increase blood flow to the area, which in turn would increase the amount of inflammation and edema.
Normal sensation when icing occurs in the following manner: intense cold, mild burning, aching, then analgesia and numbness. So expect a little discomfort before you reap all the benefits of icing.
Pre-Cautions & Contraindications
◊ Over superficial main branch of nerve (should not cause tingling or numbness further down the extremity)
◊ Over an open wound
◊ Cold hypersensitivity and intolerance
◊ Over an area with circulatory or neurological compromise
◊ Be cautious when applying to the spine, in my clinical experience necks and low backs don’t always react well to ice
◊ Icing sessions should be at least 1 hour apart
◊ Don’t ice before exercise or activity
◊ Limit icing sessions to 15 minutes
Icing is one of the most important aspects of accelerating recovery from an injury. Proper icing technique is paramount to attaining the maximum benefits from cryotherapy. It also will prevent any harmful side effects.
- Icing helps to control the edema, inflammation, and pain that results from an injury, thereby limiting the loss of function and movement
- Icing can be used for both acute and chronic musculoskeletal injuries, as well as a preventative technique
- Cryotherapy causes changes in the circulatory and neurological system to produce it’s physiologic benefits
- Protocol – cover the entire injured area (360° if it’s a joint), for a duration of 15 minutes, with RICE protocol, until the inflammation and pain has ceased
- Methods – Ice Cup Massage, Ice Pack
Cameron J. Physical Agents in Rehabilitation: From Research to Practice. Philadelpha, PA: Elsevier, 2003
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