Apr 2015 11


By: Dave Wheeler

Applying ice to an injury as a way of bringing down inflammation has been round for over 300 years.

The official name for this is cryotherapy (which is a bit fancy considering my favourite way of applying ice is to use frozen peas).


Pic by Salvatore Vuono @ freedigitalphotos.net


When to use ice treatment (cryotherapy)

Cold makes things shrivel up.

So treating muscles, tendons and ligaments with ice should be used when damaged tissue is likely to become inflamed or swollen.

Any acute injury to muscle or tendon is likely to lead to inflammation, so icing the area will help.

The word acute is important, though, swelling due to injury is likely to start happening immediately and start reducing within a couple of days. So you should apply ice as soon as possible, and continue for 48 hours. After that, there's not much point.


When not to use ice treatment

Don't use cryotherapy if the damaged muscle is in the chest. It's a long shot, but the coldness could cause a restriction in the blood vessels to the heart.


How cryotherapy reduces swelling

Injuries such as tears, ruptures, sprains and strains all lead to some degree of damage to the soft tissue (muscle, tendon, ligament).

Tiny blood vessels run through the soft tissue; it's these blood vessels which become damaged, rupture and leak blood into the soft tissue. This is what causes the inflammation.

How much swelling there is will depend on both on how bad the injury is and how many blood vessels there are in that soft tissue.

In general,

  • Muscle has a lot of blood vessels running through it,
  • Tendon has some blood vessels running through it
  • Ligament has comparatively few blood vessels running through it

Healing of the tissue won't start until the bleeding has stopped, so it's important to try to reduce the swelling/bleeding as soon as possible.

The coldness of the ice, constricts the blood vessels (this is called vasoconstriction) and reduces the flow of blood into the soft tissue.

There's also some evidence that cold reduces our perception of pain, so applying ice seems to relieve the pain of the injury.


How to apply ice to an injury

The golden rule is never apply ice directly to skin as this can cause ice burns.

Wrap ice in a damp tea-towel or damp flannel, or better use an ice pack. My personal favourite is a small bag of frozen peas wrapped in a tea-towel - these can be frozen and re-used a number of times (though of course not eaten afterwards!)

There are a number of possible icing regimes that pop up when you search on Google, but my recommendation is to stick to the traditional formula:

  1. Apply ice as soon as you possibly can after the injury; immediately, if possible.
  2. Apply for 4-8 mins every 2 hours for the first day if you can (the minimum is every 4 hours)
  3. During the second day, apply every 2-4 hours

There's a good scientific reason NOT to apply ice for longer than 10 minutes at a time - a reflex reaction called the Hunting Effect kicks in after 10 minutes of cryotherapy. This causes the blood vessels to open up again (dilate), and actually causes more blood to flow into the damaged tissue which will make the swelling worse.


What else you should do

  • Rest. Rest means stop. Don't use that part of your body, you'll make the injury worse.
  • Compression. Use a support bandage to compress the area; this will help reduce swelling
  • Elevation. If at all possible, keep the injured area raised above the height of your heart (even if this means laying on the floor with a foot on the sofa in the case of a sprained ankle) - this will reduce the blood flowing into the damaged area.


What you shouldn't you do when you've got an injury with swelling

Here are 3 things that you shouldn't do whilst the injured area is still swollen:

  1. Don't apply heat, sit in the Jacuzzi, have a hot bath, use a hot water bottle, apply Deep Heat, etc.
  2. Don't massage the area, or let anyone else massage the injured site.
  3. Don't move it - give the damaged tissue time to heal.

After 72 hours assuming that the injury isn't really severe, then those things can begin to be incorporated into your recovery.

As ever, if you think I can help, give me a call.