Icing following an injury or heavy training session is something that I have always routinely done as a person involved in sport and it has been quite surprising to me as a Sport & Remedial Massage Practitioner that many of the clients I treat are not aware of the benefits and importance of icing following injury. I have found that the majority of people when asked if they used ice following an injury said no, some of these knew they should use ice and some had no idea that they should. So to clear up the confusion I decided to clarify why following an injury or hard training session you should be reaching for your ice pack.
Inflammation and the Healing Process
To understand the role of ice in the prevention and treatment of injuries it always helps to have some understanding of the healing process our body will initiate following injury or trauma to soft tissues. When an injury first occurs the body responds with inflammation. This response is important as it signals to the body that there is a problem and sparks off the healing process with a number of cellular reactions sending neutraphils, macrophages, histamine and prostoglandin to the injury site.
Inflammation is characterised by
- heat,
- swelling,
- pain,
- restriction in function
- redness
These characteristics are designed to protect us from further injury and start the 'patch up' of the injured tissues. Pain and restriction in function limit our desire and ability to continue the activity which caused injury, heat helps defend against pathogens and begins to stimulate tissue repair; and swelling is caused by the increase in blood flow and fluid to the area.
Inflammation is essential to the healing process, therefore it's important that it occurs however there are also negatives to inflammation. If inflammation is prolonged or excessive the tissues will not strengthen and repair, healthy cells and tissues may also be targeted by cells involved in the inflammatory process causing more damage. The body is not able to regulate the inflammatory response and rather than produce 'enough' inflammation it will keep sending more cells and fluid to the area, creating more swelling, more compression of nerves and pain. This is where ice comes into the picture.
Ice in Reducing Inflammation
When we injure ourselves we do not want to stop the inflammation process, rather we want to reduce it and this is why the PRICE protocol advice is given.
P - Protect from further injury
R - Rest to prevent further injury and slow down bleeding
I - Ice to reduce blood flow, swelling and pain
C - Compression to stop fluid accumulation
E - Elevation allowing the blood to flow out of the area via gravity
Ice is an easy and effective way to reduce inflammation without completely stopping it and therefore allowing healing to commence whilst minimising some of the negatives of inflammation in excess.
Icing straight after an injury will help to provide the best conditions and opportinity to heal in the best time frame for the individual. The sooner ice is applied the more effective it will be with the most benefit being felt icing within the first 20 minutes following injury or training. however it is never too late to ice. Icing and cold will also help to prevent and reduce DOMS (delayed onset muscle soreness).
Ice should be applied 3 times a day for 10-20 minutes and should also be continued to be used in the later stages of tissue repair.
Ice as a Painkiller
Not only will ice help to reduce inflammation, it also acts as a natural painkiller having an analgesic effect. The nerves in our body prioritise the messages sent after a change in temperature higher than those sent when we experience pain, this is to prevent further damage and pain. As our body recognises heat and cold before pain applying ice to a painful injury should help to relieve some of the pain.
Reducing the inflammation and therefore swelling through the application of ice will also mean there is less fluid in the area reducing compression to nerves which also means less pain.
Precautions and When Not To Ice
There are circumstances in which ice should not be used and also certain precautions to follow to apply ice safely. You should not ice over an open wound or if you have poor circulation. Any condition which may mean you have more fragile tissue or sensitivity to cold such as Raynaud's disease, cardiac conditions and diabetes, may mean that ice should be avoided.
Ice should not be applied directly to the skin but with a barrier such as a cloth or flannel in between, it must not be left on for too long, wounds must be covered and you should regularly check the affected area.
Ice Modalities
There are many modalities to apply ice or cold and what you use will depend on the best option available at the time.
- Crushed ice - will stay the coldest the longest
- Refreezable ice packs - are reusable but will absorb heat faster than crushed ice
- Instant ice packs - often absorb heat fast and don't stay cold for long
- Ice sprays or gels - are superficial and won't have as great an effect on deeper tissue
When to Heat?
Heat should not be used in an acute phase of injury or when there is swelling. Heat will increase blood flow and send more fluid to the area which will increase compression of nerves and cause more pain. However heat can be used after the initial inflammation has subsided, generally a couple of days after an injury.
Alternating heat and ice treatment can be beneficial to tissue repair by 'flushing' out the area of waste products and encouraging nutrients and oxygenated blood into the area.
Heat can be used prior to training to help loosen tissues, reduce stiffness and increase blood flow into the area. Similar to ice modalities though heat sprays and ointments are likely to be too superficial to really stimulate the deeper tissue.
