To Ice or Not to Ice?

To Ice or Not to Ice?
Posted on 04/20/2021
To Ice or Not to Ice?

Gary Salinas, LAT, ATC
Assistant Athletic Trainer, Douglas County High School

An injury takes place, and the first instinct for most people is to throw on a bag of ice right away. We may see immediate swelling and feel pain, so we revert to age-old instincts. But one has to wonder: are we doing more harm than good? Now, I am not saying ice has no benefits in the healing process. In fact, ice does have some great properties that contribute to the healing phases. When ice is introduced to an injury site, it can cool down the tissues, reduce inflammation in the area, and block the nerve impulse, which causes numbness in the area.2,3

In order to know when to ice and when to refrain from icing, it is important to understand the healing process. After an injury, the human body goes through natural responses to help protect the site of injury. These responses are:
  1. Hemostasis (Exact moment of injury; stoppage of blood flow due to injury hemorrhage)1

  2. Inflammatory (Few minutes to 2-3 days from injury; body sends reinforcements, such as macrophages, to protect the area)1

  3. Proliferation (~3days after injury to few weeks; tissues begin to heal with scarring and collagen to strengthen the injury site)1

  4. Remodeling (Few weeks to a year-plus; advanced tissue healing, which includes advanced tissue fibers over the site then complete tissue healing)1
These natural mechanisms help aid in recovery during the injury healing process. Applying ice at the wrong time can disrupt the healing phases. Research shows that introducing ice too early to an injury can delay the healing process, thus prolonging return-to-play. Below are some facts that prove that introducing ice too early can hinder the healing process. Some adverse effects of ice application include:
  1. Slightly decrease muscle regeneration (which further weakens the muscle and its ability to rebound back to a pre-injury state.)3,4

  2. Decreases cellular metabolism needed to advance the healing stages (Satellite cells and white blood cells are needed to decrease inflammation and eliminate debris from the injury site.)3,4

  3. Muscle stiffness (which decreases elasticity hence decreases the range of motion)4
Before icing every injury, let us remember when and why we need ice. Ice is beneficial to reduce inflammation and pain. However, ice can delay the healing process if not used correctly. Ice can be your friend and is deemed important during the healing process but at the right time. A general rule of thumb is to begin icing approximately 1 hour after the initial injury so that the natural inflammatory process has a chance to work. It is recommended to ice for 10-15 minutes at a time with about 90 minutes between ice sessions. This allows body tissues to return to a normal temperature so blood flow can return to the injured area. Ice packs should not be left on an injury overnight. When in doubt, please contact your school’s Athletic Trainer or your local Healthcare Provider.

References:
  1. Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57-65.

  2. Nemet, D., Meckel, Y., Bar-Sela, S. et al. Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial. Eur J Appl Physiol 107, 411 (2009). https://doi.org/10.1007/s00421-009-1138-y

  3. Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury? Journal of Athletic Training. 2004;39(3):278-279. 
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