We all have heard of it.
The use of ice or cold therapy for reducing symptoms of acute muscle injury has been used for generations, and there’s good evidence to suggest it works.
The reason I’ve long been an advocate for using cold application to a muscle injury is partly due to the strong evidence but also due to the fact it’s a simple, easy accessible and most importantly, has no adverse side effects.
The important primary thing to know about ice therapy is that it’s not a method by which you can heal an injury but instead a very effective way to decrease inflammation for acute or new injuries.
We know scientifically it has two main ways in which is does this: by reducing swelling and by acting as a natural pain reliever.
It reduces swelling but causing blood vessels to constrict – known as vasoconstriction. This reduced the quantity of blood flow to an injured muscle, which will naturally be heightened after injury due to the natural inflammation/swelling process Also, due the ‘numbing effect’ of ice (where by the ice itself numbs the nerve ending once applied) it acts as a pain reliever.
This makes it an incredible alternative to over the counter anti-inflammatory and pain relief medications which are known to have adverse side effects.
That being said, there are effective ways to ice therapy and ineffective ways.
Effective way to use Ice
Firstly, know when it’s best to use ice:
1. Use ice when an injury is acute.
And specifically, ‘acute’ can be defined as:
An acute injury is an injury that occurs suddenly during an activity, usually from an impact, or rapid movement.
Acute injuries are also known as injuries that recently occurred, contrasting to ‘chronic’ injuries which are referred to as long-term injuries.
Example of common phrases people use to described this type of injury is:
“I sprained my ankle” or, “I twisted my back”.
When an injury first occurs, inflammation is the first response. SportsInjuryClinic.net describes the reason why:
“It’s main functions are to defend the body against harmful substances, dispose of dead or dying tissue and to promote the renewal of normal tissue.”
However we want to actively decrease the swelling when it’s not required. This article states how acute swelling or inflammation, if left untreated, can lead to long term swelling which results in increased risk of further injury, due to the rigidity in the muscle tissue that occurs with chronic inflammation.
2. Apply ice directly to skin.
Contrary to popular belief, I advise patients the apply ice directly to skin where possible.
There is a risk of ice burn when applying ice directly, that’s why it’s ideal to apply to short periods of time.
Why ice direct to skin? Any protective layer the ice is in will naturally reduce the conductivity of the ice to the desired muscle.
It’s less comfortable but more effective to apply directly to skin. Ice applied via a cold pack, gel pack or using a cold bag of peas or something else in the freezer will still work, they may just work slower.
If you don’t feel comfortable with the use of direct ice, then chose another option, as regular of use is also important, and any method by which this can be encourages would be the recommended use.
And for deeper structures where musculature of more dense and comprehensive, I do actually recommend an ice gel pack because it will take longer for the ice to conduct through all the extra fascia and tissues, and direct ice won’t allow for this. Example body areas are shoulder and hips.
3. Apply ice for short periods of time.
The perfect time to know when to stop is when the region you’ve applied it to goes numb. There’s two reasons for this:
- You don’t want to risk an ice burn, which is a possibility, just as applying direct hot water to skin can cause a heat burn.
- At the point which your skin goes numb the ice has zero effect, seeing as the region is numb and essentially ‘can’t feel the ice’, therefore the impact of the cold therapy to cause vasoconstriction of the blood vessels with not actually work (as the body won’t know ice is being applied).
Therefore leaving it on longer not only is ineffective but can cause ice burn.
Exact timings vary depending on person, for some it can be a couple of minute, and I recommend no more than 20 minutes in one session. But again, see how your body reacts and adjusts to the cold.
For direct ice it’s likely you’ll be using it for 10 minutes or under at a time, for gel packs it’s common to have on for 20 minutes at a time, as a general benchmark.
4. Apply ice frequently during the day.
Once the numbness in the region has subsided, and the body region is warm again, it’ll be okay to apply ice back to injured area.
You can do this continuously throughout the, as time allows, ideally for a minimum of 2-3 times per day.