Most of us know that when we twist an ankle or stub a toe it is a good idea to put ice on it. The questions we often get asked about using ice are how long to apply it and how often. The one factor most people leave out when applying ice is to move the joint around after the ice has been applied.
Let us explain.
Ice is usually applied immediately after trauma to reduce the resulting swelling and bruising and limit the amount of tissue damage. Ice should be applied for about 10 minutes. When applying ice you will usually go through 4 stages until the ice has its full effect. Those stages are:
- pain or discomfort from the cold application
- a warming sensation
- an aching or throbbing sensation
- relative numbness of the area
These same four stages are experienced whenever you are exposed to cold temperatures for a prolonged period of time. For those of us who live in such climate zones, when we are out in the snow or cold for too long our fingers or toes get cold, we then feel them warm up, they begin to throb and eventually we don’t feel them at all. We have to be careful frostbite doesn’t set in after long.
We call the use of ice after injury the RICE response as each letter represents one of the elements of the response. Later in this post we explain what each step does to keep the injury to a minimum and speed your recovery.
R = Rest – take your weight off the injured area.
I = Ice – apply ice to area. Different ways to apply ice are discussed later.
C = Compression – wrap a bandage around the iced area to limit swelling.
E = Elevation – raise the injured area above the level of your heart to reduce swelling.
E = Exercise – once the ice has reduced the pain (approximately 10 minutes) move the joint around (do not put your weight on the joint) to maintain the maximum amount of movement and limit the formation of adhesions in the muscle or joint. If ligament damage occurred or a bone was broken the pain will usually still be present upon movement after ice has been applied. It is always a good idea to seek medical attention if you suspect ligament damage, muscle tears or bone fracture.
How often you apply ice to an injury is really dependent upon the severity of the injury and the amount of pain and discomfort you are feeling. There is no one correct rule. We suggest applying ice two or three times a day for the first two or three days following the injury. If you have to use the joint (can’t miss work) then be sure to apply ice before and after your shift. If you can apply ice during work hours, by all means do so. It is a good idea to ask a doctor for their advice if appropriate.
Ways to apply Ice
Here are some environmentally friendly ways to apply ice.
- Ice cubes in a plastic bag ( we use double bags to avoid leaking. Massage over the affected areas.
- Small paper cup filled with water placed in freezer. Peel the paper away around the top and use the rest of the cup as a handle. Circular massage strokes over the area.
- Ice cube applied directly to skin. You can use the edge, point, or flat surface to get into tiny areas or broader areas.
- Chemical gel pack placed in freezer. Wrap the pack in a towel to prevent damaging the skin. Some gel packs can freeze up in the freezer and should be replaced.
- Immersion in a bucket of ice and water. Good for wrist & hand; ankles & foot; elbow. If you have ever plunged your hands into an ice chest searching for a beverage you know how quickly this can cool down your hand!
- Ice cubes wrapped in a moist towel.
- Bag of frozen vegetables from your freezer. I like baby peas or corn the best. The small size allows the package to conform to the body surface you are addressing. After you are done you can cook the vegetables or throw them back in the freezer.
Benefits of ice application
Reduces inflammation (swelling, pain, redness, heat)
Initial action is to cause blood vessels to constrict or get narrower to reduce the flow of blood into the affected area and thus reduce excess swelling. After a few minutes the blood vessels will begin to dilate to allow blood to reach the area for nutrition and disease control.
Slows metabolism of the cells in the area to limit the extent of tissue damage. The initial injury can damage cells. These cells release chemicals that cause capillaries to become more “leaky” to flood the area with repair materials. The resulting swelling blocks oxygen from getting to the healthy cells. By slowing down the metabolism of the healthy cells (like hibernation) the cells need less oxygen and will therefore not die from temporary lack of oxygen. This keeps the damaged area that will need to be repaired to a limited area.
Ice interrupts the Pain – Spasm – Pain cycle. When we are first injured the nervous system sends Pain impulses to the brain to cause the damaged area to be immobilized to prevent additional injury. This immobilization is achieved by contracting muscles (Spasm). The tightened muscles put pressure on pain receptors in the tissue which causes additional Pain . This cycle can become self-perpetuating and out of control. Ice application blocks excessive pain signals and breaks the cycle.
When not to apply ice
To areas affected by frostbite in the past.
If there is poor circulation in the area
Low blood pressure