So, who doesn’t love icing? We ice our cakes. We ice our cream. We even ice our wives with trinkets from her favorite jewelry store. But, within the medical community, icing and cold therapy is a topic that has historically elicited a variety of contradictory opinions. Fortunately, the topic has also been the subject of a lot of new research. After reading this new research, I have changed my opinion on the subject and have come to the conclusion that injuries should be iced for one purpose — to reduce pain– and only when absolutely necessary.
When you experience a injury due to a trauma, strain, sprain, infection or even from hard physical exercise, the immediate result is “acute inflammation.” This type of inflammation is usually short in duration, and acts to speed up the healing process. In other words, inflammation immediately after an injury is a GOOD thing; it is an indication that your body has moved into an accelerated healing mode.
The standard advice given after an acute injury is to ice and take over-the-counter anti-inflammatory medications. I certainly gave my patients this same advice for years, based on my training and all the educational material available at that time. After all, swelling causes pain by increasing the pressure on nerve endings, and as a practitioner I want to get my patients out of pain as soon as possible. So the patient ices, and the pain is diminished — this is a good thing right? Well yes and no. YES it’s good because we have a reduction in pain and the patient can function, but NO because the body’s healing process has now stopped.
When talking about the normal soreness that results from working out, I would avoid ice and cold therapy altogether. For the majority of time, it is simply not necessary. As I mentioned earlier, this also includes avoiding all NSAIDS (i.e. Ibuprophen, Advil and Aleve), since these medications can sabotage tissue regeneration. Whether we are talking about tissue repair due to injury, or trying to develop new muscle after exercise, both ice and anti-inflammatory medications can be counter-productive to injury recovery.
On the other hand, if you are dealing with an extremely acute and painful situation, then ice is a great way to reduce that pain. Use a baggie of ice or even a package of frozen peas for up to 30 minutes. (If you are using a gel pack, make sure it’s colder than ice and must have a barrier like a paper towel to avoid possible further tissue injury). Ice for no more than the first 24 to 72 hours after the injury. Yes, you will beinhibiting the healing process, but only for a short period of time. If you need to take medication because of the pain, acetaminophen (Tylenol), will reduce pain but will not reduce the inflammation.
A quick word about heat therapy: Do not heat the injured area right after an injury. Heat therapy does increase blood flow to an area, but this heat can cause an increase in inflammation, which in turn will cause an increase in pain. We need a certain amount of inflammation to heal, but too much inflammation will definitely be counter-productive. When you are ready to add heat, I recommend a microwaved rice sock or “Bed Buddy” for up to 30 minutes per hour, or even a hot bath with 2-3 cups of Epsom Salts for 20 minutes.
Ultimately, an ounce of prevention is worth a pound of cure. So, try to avoid injury by exercising wisely, avoiding soft furniture, and being diligent with hydration and daily stretching. All of these strategies are some of the best ways to avoid “the big chill.”
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