Laurel J. Freeman
Ice, anyone? Ice isn't just for cold drinks. In the
past eight to ten years, many studies have shown the benefits of ice as
therapy. Here are the answers to some common ice-related questions.What Does Ice Do?
Ice is one of the simplest, safest, and most effective
self care techniques for injury, pain, or discomfort in muscles and
joints. Ice will decrease muscle spasms, pain, and inflammation to bone
and soft tissue. You can use ice initially at the site of discomfort,
pain, or injury. You can also apply ice in later stages for rehabilitation
of injuries or chronic (long-term) problems.
During an initial injury, tissue damage can cause
uncontrolled swelling. This swelling can increase the damage of the
initial injury and delay the healing time. If you use ice immediately, you
will reduce the amount of swelling. Ice decreases all of these: swelling,
tissue damage, blood clot formation, inflammation, muscle spasms, and
pain. At the same time, the ice enhances the flow of nutrients into the
area, aids in the removal of metabolites (waste products), increases
strength, and promotes healing. This "ice effect" is not related
to age, sex, or circumference of the injured area.
What are the 4 Stages In Ice Therapy?
There are four official stages to ice. The first stage
is cold, the second is burning/pricking, the third stage is aching, which
can sometimes hurt worse than the pain. The fourth and most important
stage is numbness. As soon as this stage is achieved, remove the ice. Time
duration depends upon body weight. Twenty to thirty minutes should be the
maximum time per area. If it is necessary to reapply ice, let the skin go
to normal temperature or go back to the third stage of aching.
How Does Ice Therapy Work?
Ice initially constricts local blood vessels and
decreases tissue temperature. This constriction decreases blood flow and
cell metabolism, which can limit hemorrhage and cell death in an acute
traumatic injury. After approximately 20 minutes of ice, blood vessels in
the injured area then dilate (open) slowly, increasing the tissue
temperature, an effect which is termed "reactive vasodilation."
A study reported in the Journal of Orthopedic Sports Physical Therapy,
(Jul/Aug, 1994), found that, despite the reactive vasodilation, there was
a significant sustained reduction in local blood volume after ice was
What Does This Mean For Me?
It can mean a lot, if you are injured or in discomfort!
Ice therapy can help the area heal faster, and there will be a decrease in
pain and swelling and an increase in lymphatic drainage.
Why Ice After A Workout?
In the past 28 years, there have been many studies of
ice as a therapy tool for injuries. Many of these studies have had
conflicting conclusions, but improvements in technology are giving
researchers new data. There is no doubt in the minds of many researchers
and doctors that ice is the most widely used and efficient form of
cryotherapy in medicine today. A 1994 study sited in The American Journal
of Sports Medicine (Jul/Aug) showed ice affects not only the arterial and
soft tissue blood flow, but also the metabolism of the bone, in a positive
way. This is significant in the healing process of an injury to a joint.
When Should I Use Ice?
For the greatest benefits, use ice after exercise and
not before. In the Journal of Sport Rehabilitation (Feb/1994), a study on
the ankle was conducted to see if ice should be used on an injury before
exercise. The finding showed decreased temperature reduces the joint
mechanoreceptor sensitivity and thereby alters joint position sense,
exposing the joint to possible injury. In conclusion, cooling a body part
prior to athletic performance is contraindicated, which is academic-speak
for "probably a bad idea."
It was once believed the use of ice was only beneficial
in the first 24 hours after an injury. Recent scientific studies have
shown the benefits of ice over the long term. During the initial stage of
an acute injury (within 24-48 hours), or during the chronic stage (after
48 hours) ice can be very beneficial in promoting wellness.
Can I Ice As A Precaution?
You can use ice immediately following any workout,
discomfort, or injury. If the swelling or pain does not decrease within a
reasonable time (24 to 48 hours), consult a physician.
Is Ice Safe?
Ice therapy is very safe when used within the treatment
time recommended. Don't use ice if you have the following conditions:
rheumatoid arthritis, Raynaud's Syndrome, cold allergic conditions,
paralysis, or areas of impaired sensation. Do not use ice directly over
superficial nerve areas. In a study printed in the Archives of Physical
Medical Rehabilitation (Jan/1994), the use of ice was tested on spinal
cord-injured and able-bodied men. The results were that ice and cooling
down the body temperature may evoke a vascular response to cold stimulus
that may be mediated in part by the spinal cord and by supra-spinal
centers, causing a change in blood pressure.
How Should Ice Be Used In Conjunction
Ice can be combined with movement. Once the fourth
stage of icing has been achieved, numbness, gentle range of motion and
isometric exercises can begin. These movements should be painless,
stressing circular, spiral, and diagonal movements. Once the numbness has
worn off, re-ice and exercise again. This can be done two or three times a
day. Ice can cause changes in the collagen fibers of the muscle. Strenuous
exercise is a bad idea during an ice treatment, as this can result in
further damage to the injury.
How Does Ice Combine With Other Therapies?
In March of 1995, an interesting study was conducted on
the use of ice and ultrasound. Ultrasound is an instrument used in
assisting the healing process to damaged tissue. The study found if
ultrasound was followed by a five-minute application of ice, the muscle
significantly increased in size. When ice was applied first followed by
ultrasound, there was little or no change in the muscle fibers. One of the
important conclusions of this study is after exercising, take a shower
first, before applying ice, to receive the maximum benefits.
What Is R.I.C.E.?
When there is an injury or discomfort, a good rule to
follow for first aid is the mnemonic RICE:
R - Rest the injury.
I - Ice the injury.
C - Compress the injury.
E - Elevate the injury above your heart.
Three Icing Techniques
Ice is the easiest tool to use in rehabilitation. It is
inexpensive and very effective. The most widely used is the ice pack. To
make an ice pack, put ice (crushed is great) in a plastic bag, push out
all the air and fasten the bag.
If another bag is available, place the fastened one
inside to help prevent leaking. Put a paper towel on the site of the
injury or discomfort, and then place the ice pack over the paper towel.
This will prevent freezer burn to the skin. If a regular towel is used,
the ice pack will not get the skin cold enough to have the physiological
effects occur. If the injury is in the neck, back, or shoulder, an ice
pack can be put under a T-shirt or blouse. A person can then keep this on
while working. Ice packs are also convenient when resting. Ice packs can
be used on legs or arms. There are many types of ice packs on the market.
If purchasing one, make sure it will get sufficiently cold to achieve the
four stages of icing.
The second most used method is ice massage or ice cups.
Place water into a styrofoam/paper cup and freeze it. Place a towel under
the area with discomfort or pain to catch drips. Holding onto the cup,
tear the edge around the cup, exposing the ice. Use a gentle, continuous,
circular motion and rub the ice directly over the skin at the site of
injury or discomfort. This is good for areas on the extremities such as
knees, legs, ankles, arms, wrists, hands, and so on. Ice cups penetrate
deep into the muscle fibers. Because this is an active motion, it can
sometimes be more effective than an ice pack. The desired effect is to go
through the four stages of ice, as stated above, before moving to another
area, approximately 5-10 minutes. There are some reusable plastic ice cups
on the market, for the environmentally minded; however, paper or styrofoam
cups work fine.
The third method is the ice bath. Find a bucket or
container large enough to immerse the area in need. Place a towel under
the bucket and add ice. Try to isolate the body part that needs to be
iced. Immerse your foot for 5 to 10 minutes (20 minutes maximum). Do not
immerse your whole body in ice - doing so can cause shock and/or possibly
a heart attack.
Laurel J. Freeman, B.A., a nationally
certified sports massage therapist in Florida, has worked on many
world-class athletes and has given numerous lectures in health related
field. She developed, teaches, and practices Reprogramming Neuromuscular
Responses @ (RNR). Laurel is a member of the Florida Track Club.
Permission granted to redistribute, as
long as you acknowledge the author, FootNotes and the Road Runners Club of