Ice Ice... Maybe?
Ice has been the first step in recovery since… well, forever. But is ice always the best solution for treating injuries? Should we use ice to treat inflammation? What about heat? The age old standard has recently come under some scrutiny, and here’s why.
Ice has been the first step in recovery since- well forever. Patients often come into my office and say one of these phrases, “ I put ice on it, but I’m not even sure if that was the right thing to do” “Doc do I use heat or cold?” “ A lot of websites say that ice isn't the right thing to do anymore”. Lately a quick google search about ice shows that the gold standard for treating pain and swelling has come under scrutiny. But why?
While I must admit finding evidence based medicine to support that Icing was an efficient and effective treatment for inflammation was more difficult than I expected- but in the end ----.
Why was it so difficult? Well mostly there haven’t been a lot of robust high level studies performed on humans to lead to enough evidence that Icing is better than other treatments such as compression and elevation to relieve inflammation. And that's okay- I’m not trying to determine an either or scenario. I wanted to make sure that, after recommending icing for all these years- I wasn’t wasting everyone’s time.
What I found brought me back to physiology class- basically how things in our body work. And I was reminded that inflammation is part of our normal tissue repair process. A lot of the “anti-icers” say- exactly ! Why would we want to stop a normal process of tissue repair.
And the answer is we don't want to use ice or cryotherapy to stop it, more like control it. If there’s one anecdote that appears over and over in medicine it’s that “ too much of a good thing can be bad “. This is true for both inflammation and cryotherapy.
If left unchecked the inflammatory process can be damaging. This can happen in repetitive injury to the same location or injury left untreated- Like running on a sprained ankle or chronic plantar fasciitis.
Cryotherapy or cold therapy, helps to stop or pause the inflammatory process before it gets to the damaging stage. It has also been found to decrease pain and improved recovery. But remember too much of a good thing right? This applies to our cold therapy as well. Randomly recommending icing for every injury without guidelines can have some deleterious effects. Prolonged use of cold therapy can hamper the healing and repair process.
So after much research ICE still has a place in my treatment plan. Here are my recommendations for the best practices for ice or cyrotherapy.
Cold is indicated for use in acute injuries of 6 weeks or less.
If used for a chronic injury should be part of a therapy regimen. Use ice after exercises have been performed to promote recovery from those exercises. Use for chronic injuries should be at the recommendation of a physician or physical therapist
10 minutes sessions is optimal for ice therapy. Cold therapy applied in 10 minute sessions 3-4 times per day with at least 1 hour between each session, at the initial sign of injury.
Don’t apply ice or cold directly to skin, open wound or surgical incision. Have a thin towel or layer of fabric between closed skin and the ice pack. If icing after surgery do not place it directly over your incision.
Do not use cold therapy if you have decreased sensation to the area of injury or have been diagnosed with neuropathy.
Do not use cold therapy in the presence of any circulation disease or injury.
Safe to say, you can still turn to the old standard to treat a new injury. So grab some ice and chill out.
- Be well, Dr. D