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when to ice an injury

When to Ice for Injuries

by George Zakharia, DPTLeave a Comment

Have you ever experienced an injury and wondered if you should ice? It’s usually a great idea, but there are some rules you need to follow so you don’t worsen your injury. Read below to learn, “is ice helpful?” and “when do I ice for an injury?”

Simply put, ice is best initially for acute (recent) injuries within the first 48 hours, while heat is generally used for chronic (long term) conditions.1,2

What Is the Purpose of Ice and Is Ice Helpful?

Ice used after an acute or recent injury serves many purposes such as reducing pain and muscle spasm, allowing you to function with a better quality of life.1,3,4 The greatest purpose, however, is that ice can help minimize inflammation around the injury by constricting blood vessels and reducing bleeding into the nearby area. But we need to understand something here. Acute inflammation is actually a GOOD thing. When the body gets injured, it signals your immune system to send out an army of white blood cells to surround, clean up, and protect the area.5 This will make the area swollen and painful so you don’t do any further damage, and allow the body to heal itself.5 This idea causes some debate whether or not ice is good for you after all, but there is evidence to show that ice doesn’t impede your tissue healing,6 and that it may help return you to activity faster than not icing.7 Ice also seems to help decrease the amount of prescription medication use after surgery.1,4

When Should I Use Ice?

If you’ve experienced any of these injuries within the past 48 hours, applying ice immediately may help:

  • Joint sprain
    • Sprain – stretched/torn ligament/connective tissue e.g. twisted your ankle, felt a pop in your back, jammed your finger
  • Muscle strain
    • Strain – stretched or torn muscle e.g. felt a tear in your back/leg muscle, sore shoulder after throwing
  • Contusion – bruise/damage due to direct blow
  • Repetitive microtrauma – e.g. long run and knees are sore, sore shoulder/elbow after throwing

Research gives you a 48 hour window to ice,1,2 but icing as soon as you can to the affected area will improve pain and swelling. For additional benefits, elevating the limb above your heart, gentle pain free motion of the joint/muscle and adding compression such as an elastic bandage or elastic sleeve can help. Just ensure you don’t over tighten the compression garment. You can do this by ensuring your fingers/toes below the injury stay the same temperature before and after applying compression indicating that you are not cutting off circulation.

When Not to Use Ice

After the First 48 Hours

It is generally not recommended to ice an acute or recent injury after the first 48 hours.1,2 At this point, you may be better off protecting the area and starting to move the joint or muscle in a pain-free range. As a former athlete, I never liked the idea of simply “staying off the joint” while recovering from a strain or sprain, but rather slowly getting the muscle/joint activated while minimizing pain to help facilitate repair, strengthen and reduce muscle weakness. Research also tends to agree with this as prolonged rest may delay recovery and adversely affect the tissue repair long term,8 It is best to follow your primary doctor or therapist’s order on how and when it is safe to progress following injury.

Before Activity

It is not recommended to ice before activity. For example, if your knee hurts and you’re about to go for a walk/run, it is NOT a good idea to ice your knee before as it will make your knee more stiff and susceptible to more injury. It’s like taking a rubber band, tossing it in the freezer, and expecting it to work well. Instead warming up the knee with light exercise or a few minutes of applied heat to the area can better prepare you for your activity. Afterwards, ice can be used.

If ice just doesn’t seem to help you or if you notice that it is making your problems worse, stop icing altogether. Instead, follow some of these tips.

DOs

  • Use any kind of cold compress such as ice cubes in a sealed bag wrapped in thin cloth, bag of frozen peas, or dish soap squeezed into a sealed bag and frozen (this is a great option because it gets cold but can be adjusted around your joint )
  • Ice recommendations range from 5-30 minutes at a time, but I like to keep it safe and say aim for 10-20 minutes each session, 1-3x/day for the first 2 days
  • If you wonder if your ice is too cold, check your skin every 2-3 minutes. Remove ice if the skin is bright pink or red. Add a layer of a thin pillow case or dish towel if needed.

DON’Ts

  • Don’t ice an acute injury after 48 hours, unless you elicited new trauma to that area afterwards unless directed to do so by your medical provider (e.g. overworked the injured ankle four days after you sprained it, then you can ice)
  • Don’t apply ice directly to the skin as it can cause skin burn and irritation
  • Don’t apply ice to an open wound without properly covering the wound
  • Don’t apply ice if you lack sensation in the area (e.g. diabetic neuropathy, central/periphreal nerve damage) due to inability to sense the negative sensations of burning or tingling at the applied area.
  • Don’t continue to ice if the area begins to get numb
  • Don’t use ice packs on the left shoulder if you have a heart condition and don’t use ice packs around the front or side of the neck
  • Don’t fall asleep with the ice on you

If you’ve been icing an injury and still experience pain, contact an Athletico near you. Start by scheduling a free assessment which could get you started in physical therapy right away. Free assessments are available in-clinic and virtually through our Telehealth platform.

Request a Free Assessment

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. “Should You Ice or Heat an Injury?” Southern California Orthopedic Institute, UCLA Health, 12 June 2017, www.scoi.com/patient-resources/education/articles/should-you-ice-or-heat-injury#:~:text=If%20you%20have%20had%20a,like%20ankle%20sprains%20have%20occurred.
2. Reinold, Mike. “Is Icing an Injury Really Bad for You? What the Science Says.” Mike Reinold, Mike Reinold Https://Mikereinold.com/Wp-Content/Uploads/MikeReinold-Small-Signature-Logo-2017-Red.png, 20 Apr. 2020, mikereinold.com/is-icing-really-bad-for-you/.
3. Barber F, Mcguire D, Click S. Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1998;14(2):130-135. doi:10.1016/s0749-8063(98)70030-1
4. Raynor M, Pietrobon R, Guller U, Higgins L. Cryotherapy After ACL Reconstruction -A Meta-analysis. Journal of Knee Surgery. 2005;18(02):123-129. doi:10.1055/s-0030-1248169
5. Playing with the fire of inflammation. Harvard Medical School. https://www.health.harvard.edu/staying-healthy/playing-with-the-fire-of-inflammation. Published October 10, 2019.
6. Ramos GV, Pinheiro CM, Messa SP, et al. Cryotherapy Reduces Inflammatory Response Without Altering Muscle Regeneration Process and Extracellular Matrix Remodeling of Rat Muscle. Scientific Reports. 2016;6(1). doi:10.1038/srep18525
7. Hocutt JE, Jaffe R, Rylander CR, Beebe JK. Cryotherapy in ankle sprains. The American Journal of Sports Medicine. 1982;10(5):316-319. doi:10.1177/036354658201000512
8. Hauser R, Dolan E. Ligament Injury and Healing: An Overview of Current Clinical Concepts. http://journalofprolotherapy.com/ligament-injury-and-healing-an-overview-of-current-clinical-concepts/. Published February 25, 2019.

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