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Chiropractic Sports Injury Clinic- How Long Should You Ice?
DO NOT LEAVE ICE ON TOO LONG after an injury!
Listen to this story…
Researchers at the Dept. of Accident and Emergency Medicine at Southern General Hospital in Glasgow and Accident and Emergency Crosshouse Hospital in Kilmarnock, Scotland, made news of a case of a P.E. teacher who used a bag of frozen potatoes to get rid of pain in her foot. She let the bag sit on her foot for at least 40 minutes and the pain actually went away… temporarily! The report says the foot became discolored and the pain returned- with a vengeance. The woman lost feeling in a few of her toes. She was diagnosed with frostbite, then underwent surgery to treat the permanent nerve damage in two of her toes.
Maybe you’ve heard that after an acute injury, it’s best to ice the area for at least 20 minutes at a time. Maybe you did it for the same reasons as her. It’s possible you’ve also heard that icing reduces inflammation.
But do you know why?
Don’t take my word for it, let’s investigate the “20 minutes concept.” I want you to do a little experiment.
*Please don’t perform this experiment if you have a serious health disorder or aversion to cold- just read along.
Get an ice pack and a watch. Put the ice pack on your arm or leg for 1 minute. (After 1 minute has elapsed, do away with the ice pack.)
What color is the skin where the ice pack had been laying? For most, the skin will look white and pale.
Then put the ice pack on the other arm or leg and leave it there for 5 minutes this time. After 5 minutes have elapsed, remove the ice pack.
What color is the skin now? For most, the skin will probably be red.
What does this tell us?
Once your skin starts to cool, the initial reaction is constriction (shrinking of the diameter) of blood vessels. Which is what happened with the first 1 minute experiment- it turned white.
But immediately after some time has gone by, (the 5 minute experiment), your skin reacts to the cold by then INCREASING the size of the blood vessels in the area to send more blood to warm it up and minimize damage to the skin and tissue, which is why it turned red (this is known as the ‘Hunting Effect’).
This can be a problem for two reasons:
(1) More blood flow into the area can promote swelling
(2) Increased swelling usually results in more pain.
* Swelling occurs because blood moves in but does not effectively move out of the area. Usually you’re unable to move the affected area because of the pain, therefore your muscles and joints don’t really function at 100%.
Without this important proper working of the muscles the blood involved in the area will pool, escalating the swelling.
Now, let’s have a look at the next part.
We just saw that if the skin becomes red there is a risk of increased swelling. So, can ice decrease swelling? The answer is YES.
By using brief icing we’re able to get an analgesic or pain reducing effect. Anytime pain is diminished, muscles in the area should be able to relax and you can start to move the muscle or joint (even if it’s just a little bit).
The relaxation of the muscles and the more normalized movement results in improved circulation‚ so blood moves into and then away from the affected area. Restoring normal circulation helps removes excess fluid and inflammatory exudates from the area that contribute to the pain.
Here’s the sports injury million dollar question…
How long should you ice?
The best answer is…long enough for the analgesic or pain reducing effect to take place, but not long enough for the skin to turn red.
For most people, 2- 3 minutes can be enough to get this effect. At that point, get rid of the ice pack and do some gentle (pain free) motion of the area. Then wait until the skin returns to normal temperature and color (i. e. consistent as uninjured area on your body).
At that time, if you like, you could repeat the brief icing protocol.
The point behind this mini chiropractic “sports injury clinic” is to show you a way to manage injuries without having to be admitted to the hospital for frostbite.
Some contraindications of using ice
- Sometimes certain individuals are just hypersensitive to ice. Respect that individuality and use sparingly or not at all.
- I would stay away from using ice on injuries in the chest, especially if you have any type of heart problem. In some cases it could cause a reaction in the muscles, bringing about angina pain, if deep enough it could cause constriction of coronary arteries- not good.
- Do not apply cold to someone with high blood pressure as vasoconstriction may increase the pressure within the vessels- not good.
- Test skin sensitivity before applying ice – if a person can’t feel touch or has decreased sensation or numbing in that area they may have a nerve injury- not good.
- Anyone with a peripheral vascular disorder should consult your physician prior to using ice.
As a sports chiropractor, I’m always searching for ways to help athletes heal completely and naturally. Special thanks to David Berman, PT for sharing this with me.
Please pass this on if you thought it was enlightening.