Ice, anyone? Ice isn’t just for cold drinks. In the past 8 to 10 years, many studies have shown the benefits of ice as therapy. Here are the answers to some common ice-related questions.

What does ice do?
Ice is one of the simplest, safest, and most effective self- care techniques for injury, pain, or discomfort in muscles and joints. Ice will decrease muscle spasms, pain, and inflammation to bone and soft tissue. You can use ice initially at the site of discomfort, pain, or injury. You can also apply ice in later stages for rehabilitation of injuries or chronic (long-term) problems.

During an initial injury, tissue damage can cause uncontrolled swelling. This swelling can increase the damage of the initial injury and delay the healing time. If you use ice immediately, you will reduce the amount of swelling. Ice decreases all of these: swelling, tissue damage, blood clot formation, inflammation, muscle spasms, and pain. At the same time, the ice enhances the flow of nutrients into the area, aids in the removal of metabolites (waste products), increases strength, and promotes healing. This “ice effect” is not related to age, sex, or circumference of the injured area.

Four stages in ice therapy

There are four official stages to ice. The first stage is cold, the second stage is burning/pricking, and the third stage is aching, which can sometimes hurt worse than the pain. The fourth and most important stage is numbness. As soon as this stage is achieved, remove the ice. Time duration depends upon body weight. Twenty to thirty minutes should be the maximum time per area. If it is necessary to reapply ice, let the skin go to normal temperature or go back to the third stage of aching

How does ice therapy work?

Ice initially constricts local blood vessels and decreases tissue temperature. This constriction decreases blood flow and cell metabolism, which can limit hemorrhage and cell death in an acute traumatic injury. After approximately 20 minutes of ice, blood vessels in the injured area then dilate (open) slowly, increasing the tissue temperature, an effect which is termed “reactive vasodilation.” A study reported in the Journal of Orthopedic Sports Physical Therapy (Jul/Aug, 1994) found that despite the reactive vasodilation, there was a significant sustained reduction in local blood volume after ice was applied.

What does this mean for me?

It can mean a lot if you are injured or in discomfort! Ice therapy can help the area heal faster, and there will be a decrease in pain and swelling and an increase in lymphatic drainage.

Why ice after a workout?

Ice is the most widely used and efficient form of cryotherapy in medicine today. Ice affects not only the arterial and soft tissue blood flow, but also the metabolism of the bone, in a positive way. This is significant in the healing process of an injury to a joint.

When should I use ice?

For the greatest benefits, use ice after exercise and not before. A study on the ankle was conducted to see if ice should be used on an injury before exercise. The finding showed that decreased temperature reduces the joint mechanoreceptor sensitivity and thereby alters joint position sense, exposing the joint to possible injury. In conclusion, cooling a body part prior to athletic performance is contraindicated, which is academic-speak for “probably a bad idea.”

It was once believed the use of ice was only beneficial in the first 24 hours after an injury. Recent scientific studies have shown the benefits of ice over the long term. During the initial stage of an acute injury (within 24-48 hours) or during the chronic stage (after 48 hours), ice can be very beneficial in promoting wellness.

Can I ice as a precaution?

You can use ice immediately following any workout, discomfort, or injury. If the swelling or pain does not decrease within a reasonable time (24 to 48 hours), consult a physician.

Is ice safe?

Ice therapy is very safe when used within the treatment time recommended. Don’t use ice if you have the following conditions: rheumatoid arthritis, Raynaud’s Syndrome, cold allergic conditions, paralysis, or areas of impaired sensation. Do not use ice directly over superficial nerve areas. In a study printed in the Archives of Physical Medical Rehabilitation (Jan/1994), the use of ice was tested on spinal cord-injured and able-bodied men. The results were that ice and cooling down the body temperature may evoke a vascular response to cold stimulus that may be mediated in part by the spinal cord and by supra-spinal centers causing a change in blood pressure.

How should ice be used in conjunction with exercise?

Ice can be combined with movement. Once the fourth stage of icing has been achieved, numbness, gentle range of motion and isometric exercises can begin. These movements should be painless, stressing circular, spiral, and diagonal movements. Once the numbness has worn off, re-ice and exercise again. This can be done two or three times a day. Ice can cause changes in the collagen fibers of the muscle. Strenuous exercise is a bad idea during an ice treatment, as this can result in further damage to the injury.

How does Ice combine with other therapies?

Ultrasound is an instrument used in assisting the healing process to damaged tissue. A study found if ultrasound was followed by a five-minute application of ice, the muscle significantly increased in size. When ice was applied first followed by ultrasound, there was little or no change in the muscle fibers. One of the important conclusions of this study is after exercising, take a shower first before applying ice to receive the maximum benefits.

Article provided by: ©Laurel J. Freeman, B.A., LMT; Reprint with acknowledgment of author.