How, exactly, should you ice an injury?
Walking to the beach, I noticed the bump in the sidewalk and made a mental note to avoid it on the way back.
Of course, I didn’t.
I caught my toe and went down hard on one knee. I limped home and headed straight to the freezer for my injury cure-all: an ice bag.
But once on the couch, I realized I wasn’t really sure how long to ice my knee, if I should put the cold pack directly on my skin, or even if I should be icing my knee at all.
It turns out, I was on the right track, even if my icing technique could use some tweaks, said Johnathan Corsino, physical therapist at Cape Cod Hospital. The first stage of an injury is inflammation and that’s when cold therapy helps the most.
Ice promotes vasoconstriction, or reduction in blood flow to the injured area, he said. “It slows the metabolism of all the cells that are affected.”
Cold therapy is part of the traditional treatment for orthopedic injuries, known as RICE, which stands for rest, ice, compression and elevation.
There’s no need for a fancy ice pack; the classic bag of frozen peas works nicely, Corsino said. Just make sure to have a layer of material between the cold source and your body to protect your skin.
“The good thing about a bag of frozen peas or a gel pack is that it can conform to the body surface area,” Corsino said. “Then you can just get more contact and more temperature change by conduction, and you can affect deeper or superficial tissues better that way.”
The amount of time to ice an injury varies with where it is, Corsino said.
“If you have an injury to a wrist or an ankle, the amount of time to leave an ice pack on is a bit shorter than a big area, like a shoulder or back where the tissues might be deeper or larger. The way I was taught was 20 minutes at a time, three or so times a day for bigger areas or deeper tissues. And, just five or 10 minutes at a time for smaller areas, like an ankle.”
Corsino also suggests trying an “ice massage” -- just freeze water in a paper cup and roll the frozen cylinder over the area.
Besides icing, it’s important to remember the rest of RICE, he said. “Under-do” any physical activity, although it’s OK to keep moving as
long as it doesn’t hurt. When resting, keep an injured limb elevated -- above your heart if possible. “You’ve got to have gravity working for you to make a big difference in inflammation,” Corsino said.
And don’t forget compression. An ACE bandage or anything that provides a bit of superficial pressure will work, he said. “Again, the purpose is to help give your venous system a little more support to help move the extra fluid [from the injury] back into circulation.”
There are times not to apply ice, for example, if you have a chronic wound, impaired sensation or circulation issues. “You really don’t want to be doing anything that could contribute to worsening circulation in that area,” Corsino said.
Corsino said it’s hard to generalize about when to seek expert medical care for an injury. The trick is to know your own body and appreciate when something is beyond the norm. That might include excess bruising, an inability to bear weight, or if pain is intense enough to keep you awake at night.
“Certainly, I would say, if there’s any numbness or tingling associated with any bony injury, you get that looked at,” Corsino said. “And, with head or neck, err on the side of getting it looked at.”
