When to ice an injury?
A common question I get asked in the clinic is “Should I use ice or heat for an injury?” As a general rule we say ice is used for acute injures and heat is preferred for chronic conditions.
So then the next question is “How do I know if an injury is acute or chronic?”
Simply put an acute injury is one that has a sudden onset which is often traumatic. Common examples are straining a muscle while exercising, rolling your ankle or any type of bruising due to impact like a corked thigh.
Chronic injuries are usually associated with repetitive movements and are often referred to as overuse injuries. Some common examples of chronic injuries are stress fractures, tennis elbow, shin splints and runner’s knee.
Acute injures can vary greatly in severity and recovery time depending on the tissues involved. As always an early diagnosis is important in aiding a quick recovery and avoiding future problems due to altered biomechanics.
Signs of an acute injury include:
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- Sudden severe pain
- Swelling
- Inability to move a joint through its normal range of motion
- May have a visible dislocation or break of a bone if injury is severe
Managing a Minor Acute Injury
R.I.C.E.R. is an acronym many sports trainers and athletes use to treat a minor acute injury. It stands for Rest, Ice, Compress, Elevate and Refer.
Rest – keep the injured area supported and avoid using for 48-72 hours. This aims to reduce the amount of small vessel bleeding, tissue damage and allows quicker recovery.
Ice – apply ice to the injured area for 10-15 minutes every two hours within the first 48-72 hours. This aims to reduces blood flow, swelling, pain, muscle spasm and prevents any secondary damage to the area.
Compression – apply a firm elastic bandage over the area, extending above and below the painful site. Leave on at all times for the first 48-72 hours. Remove for application of ice. This causes blood vessel constriction reducing bleeding and swelling.
Elevation – raise the injured area above the level of the heart at all times. This can be achieved by propping your limb up on pillows when seated or lying, or using a sling for upper limb injuries. This aims to reduce the swelling and small vessel bleeding in the area.
Referral – as soon as possible, see a medical professional for an early diagnosis and quicker recovery
Avoid HARM
HARM stands for Heat, Alcohol, Running/exercise, and Massage. HARM represents 4 factors that you should avoid in the early stages of injury in order to maximise healing and recovery. While RICER focuses on minimising bleeding and swelling, HARM covers factors to avoid – all of which will increase circulation to the damaged area.
No Heat – heat will increase bleeding to injured area. Heat increases blood flow to the region which increases the swelling.
No Alcohol – alcohol increases bleeding and swelling to injured area by dilating your blood vessels.
No Running – running or exercise increases may delay healing as blood clot/haematoma formation may be compromised due to increased blood flow to the injured area.
No Massage – massage increases swelling and bleeding to injured area. Avoid during initial stages of injury. Massage performed over the affected area will increase trauma and swelling in the area.
How Ice Therapy Works?
Ice therapy works by reducing blood flow to the area, which can significantly reduce the inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also help relieve pain.
Applying Ice Therapy?
There are a number of different ways to apply cold therapy to an affected area. Treatment options include:
- ice packs or frozen gel packs (can be as simple as a bag of frozen peas)
- coolant sprays
- ice massage
- ice baths
Helpful Tips On Using Ice
- For home treatment, apply an ice pack wrapped in a towel or ice bath to the affected area. You should never apply a frozen item directly to the skin, as it can cause damage to the skin and tissues.
- Be careful when using it on children as they have a lower tolerance, people with circulatory problems and those who are sensitive to the cold.
- Apply cold treatment as soon as possible after an injury.
- Use ice therapy for short periods of time, several times a day. Ten to 15 minutes is fine, and no more than 20 minutes of ice therapy should be used at a time to prevent nerve, tissue, and skin damage. You can elevate the affected area for best results.
- Give the tissue time to recover from ice therapy. This is approximately 2 hours between treatments.
- Regularly check the temperature of the tissue to make sure there is no damage such as freezer burn.
