Knowing how to ice an injury or chronic condition may help save you unnecessary pain and speed recovery. Inflammation is a necessary component of tissue healing. It is the first physiological process to the repair and remodeling of injured tissue. You cannot have tissue repair or remodeling without inflammation. BUT… the inflammatory process (though natural and healthy) can also be incredibly painful. Icing is mostly just a mild, drugless way of dulling the pain of inflammation.
This being said, knowing when to properly use ice vs. heat is vital in tissue rehabilitation and speed to recovery.
When to use Ice
1. Arthritis. Applying ice (a bag of peas forms nicely) helps reduce painful inflammation (Remember, heat will soothe pain from joint stiffness).
2. Carpal tunnel syndrome. Ice application can reduce swelling in the carpal tunnel. This allows the median nerve more room creating less aggravation.
3. Headaches or Migraines caused by tension and stress. Applying an ice pack to the forehead, back of neck or around the head will cause the blood vessels to constrict pushing the over flow of blood away from the head thereby reducing headache discomfort.
4. Repetitive stress or overuse. Ice application can help reduce pain caused by swelling and inflammation.
5. Tendinitis and Bursitis. Ice application can help reduce pain caused by swelling and inflammation. However, do let the body’s natural inflammatory response have a go in the healing process.
6. TMJD (Temporal Mandibular Joint Dysfunction) or Post Dental Work Pain. Applying ice to the jaw area and outside of the mouth can help relieve pain caused from inflammation and dental work.
7. Freshly pulled muscle or a new case of IT band syndrome) Icing will help decrease the pain felt from the injury itself and the effects of inflammation.
8. Bee sting & Bug bites. Clean the area & Ice for 20 Min. The coldness decreases inflammation, numbs the pain, constricts blood vessels and slows the melittin (venom in bees).
9. Before Prescribed Strengthening Exercises Icing can also be used to reduce discomfort before doing prescribed strengthening exercises to an injured area such as the ankle, knee, hand, wrist, elbow, etc.
10. Ankle Sprain** Immediately after injuring an ankle, begin RICE, That means get off the injured foot; prop it up, if possible, higher than the heart; wrap it in a compression bandage; and apply cold for 10-20 minutes and resting for 10 minutes in-between icing. If you are unable to bear weight after this type of injury, or if there is significant swelling discolouration, or deformity, you should seek medical treatment from a doctor.
**With most acute injuries, you want to allow the body’s natural inflammatory response to have a “go” in the healing process. Icing is mostly just a mild, drugless way of dulling the pain of inflammation. Use what feels right to you. See #7 below.
When not to use Ice
The following are contraindications to cold therapy. This means that if you have any of the below conditions then using ice may likely worsen the condition.
1. Poor Sensation (Anesthesia) – When there is an area of numbness or altered sensitivity, cold therapy will not be felt by the patient and could therefore damage the tissue.
2. Cold Hypersensitivity – There are many forms of cold hypersensitivity. Do not allow the person receiving cold therapy to get chilled, keep them warm during treatment.
3. Cold Erythema – Exposure to cold can cause a rash characterized by redness and itching. This can cause severe pain and muscular spasms
4. Cold Hemoglobinuria – The cold can cause the red blood cells to break down so quickly that the hemoglobin cannot combine with blood proteins.
5. Raynauds Disease – This disease causes some areas of your body (such as fingers & toes) to feel numb and cold in response to cold temperatures or stress.
6. Cold Urticaria – Also known as hives. During re-warming icing, your body releases a histamine causing red, itchy welts on the skin
7. In an acute injury – (Pain that is usually temporary of sudden onset). There have been misconceptions to this type of pain when using ice. Gabe Mirkin, MD—the physician who coined the term RICE; Rest, Ice, Compress, Elevate—has since said he was wrong. “Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” Gabe Mirkin, MD, March 2014. However, once again, the inflammatory process (though natural and healthy) can also be incredibly painful. Icing is mostly just a mild, drugless way of dulling the pain of inflammation. Use what feels right to you.
How to use Ice
First – Never apply ice packs directly onto the skin (this may cause ice burns), wrap packs in a T-shirt or pillow case with one layer only. Here are a few different types of cold and ice packs
- Ice Towel, wet a towel and wring it. Place in freezer for 20 min (or make a few ice towels for later use) now place and mold the frozen towel on the injured or sore area
- Ice Pack, Purchase ready made or put about 1 lb (0.5 kg) of cubed or crushed ice in a plastic bag, add a small amount of water then place in pillow case or T-shirt
- Frozen Veggies, Bags of frozen peas or corn are inexpensive, last 10 to 20 minutes, and mold well to the body
- Homemade Slush Pack, Mix 3 cups water and 1 cup rubbing alcohol in a freezer bag. Seal and place in freezer until slush forms. Refreeze when slush melts
- Immersion in Cold, Fill a sink or bucket with ice water and immerse the area to be iced. Use “CBAN” (cold, burning, aching, numbness) for length of time to immerse to prevent tissue damage
Second – Apply ice pack to area being treated for 10-20 minutes, this may be repeated every 2 hours as needed or as recommended by your Registered Massage Therapist
Third – Do not apply ice for longer than 15 to 20 minutes at a time, and do not fall asleep with the ice on your skin.
Note: Never use commercial ice packs around eyes, they could leak and cause chemical burns. Always use natural ice, frozen veggies or frozen towels for eye area.