Icing – when is it best left for cakes?

Posted by on 22 Jan, 2015 in Cold, Treatments | 0 comments

Icing – when is it best left for cakes?

Most of us hurt ourselves occasionally and many of my patients ask about using ice on injuries and whether this is helpful. There are times when icing an injury is helpful and other times when it’s best not to ice. One of the most important things to remember with any injury is that we cannot ‘speed up’ recovery but we can slow recovery down if we don’t provide the optimum conditions for healing.

So where does ice come in? Ice is cheap, it’s generally fairly easy to get hold of and it can alleviate some of the symptoms from sprains and strains, bruises and tendon injuries. It is certainly useful when tissues are damaged and inflamed (ie. in recent injuries). The 4 signs of inflammation are redness, swelling, heat and pain – if you have all of these you can generally assume that ice may help in numbing the pain, although the effects will only be temporary and the main reason ice is used is simply as an analgesic (pain reliever).

At a cellular level within the body, ice will slow the metabolism down and put the tissue cells surrounding an injury into ‘cold storage’. This is a good thing as these tissues may otherwise die from a lack of oxygen and thereby add to the total area if tissue damaged (this is known as secondary hypoxia).

If you have an open wound then caution is necessary – the inflammatory response is necessary to prevent and fight infection and is an essential, if annoying, part of the healing process. In such cases a little ice is ok, but don’t overdo it. Make sure you don’t use ice directly on open wounds as you may introduce bacteria, but icing around the edges is an option.

If you have a recent injury in which the skin is not broken (a bruise, muscle tear or a sprain) then ice away if you feel that it helps. Unless you have an aversion to ice, a heart condition or lack of sensation in the area you’re planning to ice, the risks are minimal. You can cause ice burn but this takes a couple of minutes of applying ice directly to the skin and you’ll start to feel discomfort and want to remove the ice before you can cause any lasting damage.

How about the post-event ice bath? Some well-known sportsmen and women are enthusiasts but could it be psychological? Personally I can’t think of many things worse than immersing myself in icy cold water voluntarily, but what does the evidence tell us? Well sadly, to date, there is not a great deal of scientific evidence either way. A very small study in 2013, reported in the Journal of Strength and Conditioning Research (Tseng et al), showed that for severe muscle soreness post exercise, ice seemed to do more harm than good. For that reason, I’ll steer clear for the time being!

So what about longer term injuries that have become chronic? I’m talking about conditions such as plantar fasciitis, runner’s knee, Achilles tendon issues, tennis or golfers elbow. What is happening here is not the classic inflammatory response of recent injury, but more of a degeneration of the tissues involved. In these conditions anti inflammatory medications (such as ibuprofen) which are intended to supress over activity of the immune system are not generally going to work well. Again in such situations ice can numb the pain so is therefore worth trying and it may even stimulate tissue healing – although this has not been proven in any studies to date.

Are there times when you should avoid ice? Ice is good for most recent injuries and as mentioned can be helpful in some longer term problems. However if you have a lower back or neck complaint then try heat first. Most back and neck pain is not due to recent injuries and therefore ice is of limited use.

The next question is how much and how often? There are no hard and fast rules when it comes to using ice. If you’re using ice cubes and massaging these over the area then once it starts to go numb, stop and let the tissues warm up again before re-applying. Depending on the area of your body this can take about 1-3 minutes and your fingers may go numb first! If you are using an ice pack then it’s safe to use this for a little longer each time, but again be aware of the sensation and remove the pack once the area is numb. Give the tissues time to warm up again you can repeat the icing. So long as you allow the tissues to warm between each application of ice, you can repeat as often as you want or as is practicable.