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Almost Everything You Need to Know About Ice and Injuries

May 20, 2003 12:13 PM

By Jim Brown, Ph.D.

Although the use of cold and heat applications is an accepted part of the treatment of tennis injuries, there is still confusion about specifics and uncertainty about how they work.

Here are some things we know about ice applications. They decrease temperature, inflammation, rate of local metabolic activity, circulation, muscle spasm, and pain. How and when ice and heat do all of those things depends on the type of injury and the timing of treatment. Following are commonly asked questions about cryotherapy.

When should you apply ice to an injured area?

As soon as possible.

How long should you continue to apply ice?

Several times a day for 48-72 hours or until the swelling has been controlled, whichever comes first, but there may be cases of severe bruises when it is used for up to seven days.

Are there other times when ice applications are useful?

Yes. Ice is used during therapy to relieve pain, to allow for range of motion exercises that might not otherwise be possible, and to prevent additional swelling following rehabilitation exercises. It is also used as an injury prevention measure following particularly demanding periods of exercise (for example, pitching a baseball for several innings).

How long at a time should ice be applied?

For 15-30 minute periods separated by 45-60 minutes between applications. The duration may also depend on the type and depth of the injury and the player's body type. Injured ankle and knee ligaments lie closer to the surface of the skin and require less icing time than do injuries to the thigh or biceps muscles. In thin athletes, significant muscle cooling may occur within ten minutes, while in heavier athletes it make take 30 minutes to get the same results.

How does ice reduce pain?

In lay terms, it deadens the area. In medical terms, pain is decreased because nerve end thresholds are reduced.

How does ice inhibit inflammation?

The exact manner is not known. It may not have a direct impact on initial inflammation, but instead limit the extent of secondary damage.

When should you use ice rather than heat in regard to motion?

Use ice if motion is limited by pain. Use heat if motion is limited by stiffness.

Which is more effective, an ice bag or ice massage?

Ice massage cools muscle tissue faster than ice bags. If the injury involves a small area, immersing the area in a bucket of ice for 5-10 minutes is also an option.

Is there a best way to administer an ice bag?

The most common method of icing is to place a wet towel over the affected area, then position the ice bag on top of the towel, and finally, use a bandage to keep it in place and to apply pressure.

Is there a best way to administer an ice massage?

Many trainers freeze water in a paper or Styrofoam cup, then turn the cup upside down, and peel the paper away as the ice melts against the skin. If you use an ice cube, keep a towel at hand to absorb the melting ice water.

What can I expect to feel during an ice application?

The sensation of an ice application will follow this pattern: cold, burning or pricking, aching, and numbness. As soon as numbness occurs, remove the ice.

Are reusable chemical ice bags effective?

They are acceptable methods (in varying degrees of effectiveness, depending on the product) of administering cold applications as long as the person is careful not to place them directly against the skin and is careful not to apply so much pressure that the plastic bag breaks. Some gel packs don't stay cold long enough to be effective. Commercial cold packs are good for emergencies because they are easy store and transport.

Are there some athletes who should not use ice applications?

Yes. They include those who are highly sensitive to cold therapy, those who may injure themselves by applying ice too long, and those with diseases such as diabetes in which a diminished flow of blow to vessels near the skin could be harmful.

What are the rules for using ice?

1. Do not place ice directly on the skin.

2. Stop icing once the skin is numb.

3. Use caution with commercial cold packs.

4. Do not use ice on blisters or open cuts.

5. Use caution when icing the elbow or knee because nerves in these areas can be damaged by icing too long.

6. Do not use ice prior to playing or practicing.

7. Do not immerse your whole body in ice.

Next column: Heat Applications and Injuries

Jim Brown will be contributing new content to this site on a monthly basis. If you have a question for Dr. Brown please feel free to email him at sportsmed@mindspring.com.




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