While watching almost any sporting event, did you ever notice that the moment an injury occurs – the first thing they reach for is ice? There is no difference between your weekend warrior’s sprained ankle and the sprained ankle of any athlete in organized sports. In fact there is no difference with the sprained ankle is a relatively sedentary individual. Ice is the first thing we should be thinking about when any injury happens. Ice does NOT reduce swelling once it has already occurred.

When a patient in physiotherapy is finished being treated – ice is often the choice made to address any potential irritation which may have occurred. Sometimes ice is used by the therapist to start the treatment. It all depends on your injury and what they want to accomplish in your treatment. The idea is to decrease the pain, prevent further swelling and reduce the need for oxygen by the tissues. There are many more effects of ice on the body, but these three are the ones we most often rely upon.

We have all heard the saying “ice for 24 to 48 hours then apply heat.” This is wrong for many reasons. When a person gets injured – they should rest and not move initially. Most people these days are often too busy to get better… they keep moving and try to maintain their busy lifestyle. This will keep their new injury in an acute irritated state. Ice and rest should be the most important things to think about. One example of this would be a person with any lower body injury. Let’s say for example you have sprained your ankle. Walking on it will keep the ankle irritated and delay recovery. Since it is irritated any application of heat will increase the circulation and worsen the swelling… thereby delaying the recovery even more.

There are several different ways to apply ice. The idea is to cool the deep tissues, therefore creams and ointments DO NOT apply as actually icing an injury. The following are some of the popular ways to ice.

Ice cubes and crushed ice. Place the ice in a WET towel and apply to the skin. Dry towels and covers will not allow the area to get cold enough…

Gel packs are popular and MUST be applied with a wet towel between your skin and the gel. A dry towel does not allow the area to get cold enough. Compression should be avoided.

Ice water immersionis a great way to ice because all sides of the injured area are cooled. This is good for ankle sprains and should be done for a maximum of 10 minutes.

Frozen vegetables have been studied and the only problem is they thaw… therefore they do not stay cold enough long enough… if you use a bag of frozen vegetables – use a wet towel between your skin and the bag.

Timing your ice application is important. Too long (1 hour or more) can damage superficial nerves and can cause injury to the skin (frostbite for example). Studies have been done which showed a finger joint is cooled through in 5 minutes. Other body parts are covered by muscles which have a good blood supply – they can keep warm longer. Therefore ice should be applied longer. For example a shoulder can be iced 15 to 20 minutes depending on the thickness of the muscle covering it, and a thigh may need 20 to 30 minutes to cool deeply enough to matter.

Contraindications…The only exceptions to icing are people who have nerve damage where the skin is numb, when the person has a hypersensitivity to ice, when a person has circulatory problems for various reasons or cardiac conditions. You should never apply ice for long periods (1 hour or more) and you should not compress gel packs onto a body part with elastic wraps.

What should you expect during and after your ice application? Initially ice is not comfortable (you get used to it though). This discomfort should settle down quickly. As time goes on there can be an ache, there can be tingling sometimes and then it progresses to feeling numb. If the pain and aching gets worse over time, stop icing and ask your therapist…

You can’t really go wrong with ice – but you can go very wrong with heat if you use it incorrectly. Ask your therapist which is right for you…