Icing on the Ache!

Icing an injury is one of the oldest and best known injury treatment strategies, yet there is often confusion among athletes and coaches as to what injuries they should ice, how often and for how long.  Based on current research there are no definite answers to these questions however here are some basic guidelines you can follow:

1. Always ice an acute injury involving muscle tears and joint sprains.  Acute injuries are those that occur suddenly, such as an ankle sprain, which usually result in swelling and inflammation.  Although inflammation is a natural response to an injury, excessive inflammation can cause further damage.  Once an injury has happened, the faster you can get ice on it, the better.

2. How long do I ice it for?  That will depend on the whether the injury is superficial or deep.  The important thing to remember is that the tissues of the injured area must reduce in temperature in order for the icing to be effective.  It is recommended that if the injury is deep you may need to ice it for up to 20 minutes.

3. The first 48 hours is when you need to be the most diligent; icing every two hours is ideal.  The cold will help to dampen the pain so icing 15-20 minutes four or five times daily would help immensely.  Once the initial inflammation has gone down, icing is less effective and can be performed less frequently.  Many people switch to heat too quickly so give yourself 3-5 days before applying heat.

4. Chronic and long-term injuries to tendons, joints and bone do not usually involve an inflammatory response and therefore icing these injuries is not very effective.  Instead, those 20 minutes can be better used by performing rehabilitative exercises that try to address the injury.

5. When icing, always make sure that there is a barrier to the skin to avoid frostbite; keeping the ice in a thin towel is generally sufficient.  There are also many other commercially available alternatives such as gel packs, Cryocups or Mojiknees that can also be very handy.

If you get hurt stop playing, since continuing to play could cause more harm.  Keep in mind that limiting your mobility, elevating the affected area and pain relievers all help the healing process, so make sure you treat your body well and let it rest.

References from the SIRC Collection: 

1. Bleakley C, Costello J, Glasgow P. Should Athletes Return to Sport After Applying Ice?. Sports Medicine. January 2012;42(1):69-87.
2. Clover J. I.C.E. Can't Do It Alone. Coach & Athletic Director. September 2001;71(2):58.
3. How to return FROM INJURY. Athletics Weekly (Descartes Publishing Ltd.). January 15, 2009;:30.
4. Johar P, Grover V, Topp R, Behm D. A COMPARISON OF TOPICAL MENTHOL TO ICE ON PAIN, EVOKED TETANIC AND VOLUNTARY FORCE DURING DELAYED ONSET MUSCLE SORENESS. International Journal Of Sports Physical Therapy. June 2012;7(3):314-322.
5. Plaster L. A BETTER WAY TO ICE AN INJURY. Runner's World. August 2004;39(8):44.
6. Speed up recovery from injury. Athletics Weekly (Descartes Publishing Ltd.). May 22, 2008;:31.