Athletic Training Column

Ice, ice, baby!

By Jenn Mroz | Sep 19, 2013
Photo by: File Jenn Mroz

Ever wonder which is better to use when you have an injury:  ice or heat?  When asked, most people would probably prefer to use heat, rather than ice.  Too many times I’ve had athletes tell me that they had some sort of pain, so they sat in the hot tub and woke up feeling worse.  
While there are benefits to each, it’s important to use them at the proper time in the healing process to speed recovery.  In this column, I will explain how to use these modalities to maximize their benefits.
I am a big proponent of cryotherapy, or the use of ice, in reducing pain and swelling.  When there is an injury to the soft tissue (muscle, tendon, ligament), there is also damage to the blood vessels.  
This leads to bleeding and inflammation.  Cryotherapy constricts these blood vessels, which reduces the amount of swelling.  
This is important because within the swelling are chemicals (called chemotaxins) that cause pain.  Heat, on the other hand, will dilate blood vessels and increase swelling.  A perpetual pain-swelling cycle can occur.  The swelling causes pain; the pain causes swelling; the swelling causes pain, and so on.  
That cycle needs to be broken somehow, and ice is the best start for a recent injury.  Not only does it reduce swelling, ice acts as an analgesic and reduces pain as well.
So, what types of cryotherapy are there?  Ice bags are probably the most common method.  Frozen peas work just as well as a bag of ice, and sometimes even better because the peas mold better to the injured area, maximizing the surface contact; plus they can be easily refrozen and used again.  Ice cups work best on tendinitis in the knee and shoulder, as well as shin splints.  
At Tuscola, I have a cold tub that is great for ice baths.  Believe it or not, my athletes have a love/hate relationship with the cold tub!  They may hate the first few minutes of it, but they love the results they feel the next day.  It’s a great way to ice larger areas that are sore instead of trying to use multiple ice bags.  
I’m not a big fan of chemical packs due to the risk of chemical burns, or the topical creams that claim to be icy (which is not the same as using ice).
There is some confusion as to how long to use ice.  My rule of thumb for ice bags is 20 minutes, 5-10 minutes for ice cup, and 10-15 minutes for the cold tub depending on the temperature.  Any longer than that and the blood vessels actually start to dilate, as if heat was being used.  As far as the number of days, some say use ice for the first 48 hours after an injury and then switch to heat.  I don’t usually like to put a time frame on it, only because not every injury responds the same way for everyone.  
There may be stresses placed on the injury that continually cause more swelling to occur.  With that being said, I do think that contrast treatments (alternating ice and heat) can be beneficial after the first 72 hours, as long as the final treatment is ice.  
The contrast will cause a “pump” effect by dilating the blood vessels with heat, then constricting them with ice.  I’ve seen good results with reducing swelling in a chronic injury where the swelling has become thicker and doesn’t respond to the use of ice alone.
Precautions do need to be taken when using cryotherapy.  There are situations with which you need to be careful:  areas with sensation loss, superficial nerves (like in the elbow), injury to the eye or genitalia, open wounds.
In these cases, it’s best to insulate the injured area with a towel before applying ice and reduce the amount of time the ice is used.  As strange as it sounds, people can be allergic to ice.  It’s not very common, but it can happen.  While it’s normal to see the skin under the ice turn red, I had an athlete whose entire body broke out into hives within minutes of putting ice on her knee.
I realize I haven’t mentioned heat much so far.  As an athletic trainer, I’m used to dealing with acute injuries where the goal is to reduce swelling as quickly as possible.  Honestly, I don’t use heat very often.  I reserve heat for those chronic (long-term) injuries where the swelling has gotten thicker and doesn’t respond to ice any longer.  In these cases, the dilation of blood vessels and increased blood flow is beneficial in loosening the swelling and allowing it to be eliminated easier.
While there is a time to use heat, remember ice is your friend.  By using heat too soon, you could be prolonging your recovery period.  When in doubt, use ice!
With fall weather approaching, so comes cold and flu season.  Next time I’ll discuss how to lower the risk of getting sick.  
Until then, play safe.

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