Fitness Article of the Month
March 1997

This article gives you everything you ever wanted to know about ice therapy. I personally feel it's better than any drug out there, and can heal an injury much quicker than normal, if applied correctly. I'm hoping that you won't need to apply this info, but if you do, here is the good stuff. Best of Health. RM

Giving Injuries the Cold Treatment
Bryant Stamford, PhD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 3 - MARCH 96

When you sprain your ankle or have a similar injury, tissue is stretched and torn, and swelling occurs. Swelling interferes with healing, so anything that will prevent or reduce swelling should help you recover from a minor injury more quickly.

The sooner you attend to swelling after an injury the better, and the best approach is to apply cold directly to the injured area right away. (See "A Time for Cold, a Time for Heat") Cold shrinks the blood vessels, which reduces bleeding in the area and helps to prevent swelling. It also helps prevent the muscles from going into spasm (involuntary contractions) and relieves pain.

The use of cold as a treatment is as old as the practice of medicine, dating back to Hippocrates. Today, methods of applying cold are more advanced than they were in 400 BC, but the principles and the need for precautions are the same. When you apply cold, the skin will initially feel cold, often followed by relief of pain from the injury. As icing progresses, you will feel a burning sensation, then pain in the skin, and finally numbness.

To avoid skin damage, stop when the skin begins to feel numb. (This is different, though, from the "numbness" you feel early on as the cold relieves injury pain. Keep icing after this pain subsides.) Applying too much cold for too long can cause frostbite or even nerve damage. Also, cold treatment is not for everyone (see "When to Avoid Cold Therapy").

The length of time you apply cold will vary depending on the method and location of the injury (see specifics below). Areas with little body fat (like the knee, ankle, and elbow) do not tolerate cold as well as fatty areas (like the thigh and buttocks). So, for bonier areas, keep to the low end of the recommended application ranges listed below.

For best results, apply cold at regular intervals throughout the waking hours of the day, allowing a few hours between treatments. Time off will keep cooling effects from accumulating and will allow the skin to return to normal temperature. An ice bag remains--for good reason--the cool treatment of choice for most people, but several options exist:

Ice Bags

Gel Packs

Chemical Cold Bags

Immersion

Ice Massage

Strengths: Ice massage involves rubbing ice on the skin with a circular motion. It is easy to apply and focuses the cold on the injured area. A useful approach is to fill a paper or foam cup with water and freeze it until needed. Then peel away the top to reveal the ice and hold the bottom of the cup to apply. Ice cubes or chunks can also be used.
Weaknesses: The cold tends not to penetrate as deeply nor last as long as the methods listed above.
Application time: When applying to bony areas such as the ankle, apply for only 7 to 10 minutes. Double the time when applying to fatty areas such as the thigh or buttocks.

Combination Treatment

To maximize the benefits of cold therapy, think RICE: rest, ice, compression, and elevation. So in addition to cold therapy, rest your injury, apply elastic wrap snugly, and keep the injured area raised. New technologies combine RICE aspects. Cold tape, for example, compresses and-because of a chemical reaction-applies cold to an injured part.

Putting Injuries on Ice

Whichever method you choose, remember to ice early, ice often. But not too often. To avoid harmful effects like frostbite, let your skin recover between cold applications, and listen to your body.

A Time for Cold, a Time for Heat

There has been controversy over the years as to when to apply cold and when to apply heat. Because heat stimulates blood flow, it promotes healing just as cold does. It can also relax muscles and ease pain.

But heat can make swelling worse. That's why cold is best right after an injury and heat is recommended for later, when swelling abates. As a rule of thumb, use ice for at least 48 hours after injury. Then, when the swelling is gone, you can apply heat. (Back to article)

When to Avoid Cold Therapy

Using cold therapy may not be a good idea for some people. Those who are very sensitive to cold will not be able to tolerate icing long enough to do any good. Conversely, those who have a high tolerance to cold-or who pride themselves on being "tough"-open themselves to injury by applying cold therapy too long.

People with problems in the blood vessels near the skin should avoid cold therapy, especially those with Raynaud's phenomenon (a condition in which the blood vessels in the fingers, toes, ears, and nose constrict dramatically when exposed to cold and other stimuli). If you suspect you may be at risk because of diabetes or another condition that can diminish blood flow, check with your doctor before applying cold to an injury. (Back to article)

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr. Stamford is director of the Health Promotion and Wellness Center and professor of exercise physiology in the School of Education at the University of Louisville, Kentucky. He is also an editorial board member of The Physician and Sportsmedicine.

This fitness article is for educational purposes only. It is not medical advice and is not intended to replace the advice or attention of health-care professionals. Consult your physician before beginning or making changes in your diet, supplements or exercise program, for diagnosis and treatment of illness and injuries, and for advice regarding medications. Thanks. RM