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Thursday, 9 January 2014

Why Ice?

As you can gather from the name of this blog, I fully believe in icing injuries.  Any athlete or patient will tell you that I don't believe in heat only ice when it comes to treatment of musculoskeletal injuries.  There has been a lot of new information coming out saying that icing an acute injury is detrimental to healing.

When dealing with an acute injury the use of cryotherapy (application of cold) to the area is important for the first 24-48 hours.  The use of ice decreases pain and muscle spasm as well as blood flow, inflammation and edema.  This is due to the stop of tissue hypoxia and additional tissue injury.  When managing an acute injury the reduction of all of these aids in recovery and rehabilitation.

Reviews of research done on cryotherapy shows that more detailed studies need to be completed.  The research has proven that the application of ice on acute injuries does decrease pain, which will decrease spasm caused by the pain-spasm cycle.  Since muscle spasm decreases range of motion, this decrease in pain will lead to earlier improvement in range of motion and subsequent earlier start to rehabilitation.

The principle of RICE is still the standard when dealing with acute injuries.  Rest, ice, compress and elevate the injured area for the first 24-48 hours.  When icing on average for topical application the ice should be applied for around 20 minutes depending upon the size of the area needing treatment and the depth of soft tissue.  Topical application will reduce tissue temperature to a depth between 2 - 4 cm.

When applying ice, no matter the mode there are 4 sensations that you will experience.  Starting with cold, progressing to burning, achy/dull and finally numb.  When determining how often to apply the ice, the area needs to come back to normal body temperature before reapplying.

No matter the type of soft tissue injury, be it sprain, strain, contusion or post operative the application of ice is the still the best way to decrease pain and inflammation without the use of medications after an acute injury.

Articles used
Hubbard, T.J & Denegar, C.R. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? Journal of Athletic Training. 2004 Jul-Sep; 39(3): 278-279
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

Nadler, S.F, Weingand, K, Kruse, R.J. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner Pain Physician.  2004;7:395-399, ISSN 1533-3159
http://www.painphysicianjournal.com/2004/july/2004;7;395-399.pdf

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