The Big Chill Part 1: Cold Therapy for Injury Recovery

5th July 2014

What to do in the early stages of a muscle injury. 

As you can imagine, I see a lot of people hobbling into the clinic that have suffered some kind of injury and I’m always amazed at how these clients go about basic injury First Aid. By far the most important part of any strategy to recover from injury is what you do in the first 72 hours so this article is going to cover the best practice. 

Muscular injuries come in many forms and often it's hard to place your finger on exactly how you came to be in such acute pain. There are the obvious times when you are partaking in some kind of physical activity and you suffer a debilitatingly sharp pain which inhibits you from taking another step, and there are the other days where you struggle to understand quite how you came to hurt yourself. Either way you are now in the Acute stage of injury.

The Acute Stage. 

At this time you are at the most critical point. You need to make a decision as to what you can do to deal with this injury. Do you ignore it and hope it will go away in a couple of days? Do you go and relax in a nice hot bath? Or do you brave the spine chilling sensation of placing a bag of peas on your injury? 

I ask these questions of my clients all the time and it's always interesting to hear their response. “Its the middle of winter and I couldn’t face putting ice on it so I got the hot water bottle out instead and it seemed to ease the pain for a while”. Or, “I left it for a few days and the pain turned into a constant ache so I used some Deep Heat to ease it but nothing seems to be working”. 

Heat has the effect of increasing blood flow to an area, and therefore increasing the pressure and more importantly the metabolic rate of the tissues. This increase in metabolic rate is hugely damaging to the tissues around the injury site making the recovery time longer. The original area of injury that needed to repair grows larger as this increased metabolic rate damages more cells. interestingly, heat generation is a natural part of the body’s reaction to injury but too much for too long can slow down the healing process. 

This is where Ice comes into play. Ice is part of the basic first aid protocol known as R.I.C.E. standing for Rest, Ice, Compression, Elevation. Depending on the type of injury the use of each of these treatments is more or less important but the two that are always used are Ice and Compression. 

Let's start with Ice. Ice by its very nature cools the affected site and therefore reduces the heat generated by the body. This cooling effect reduces the metabolic rate and restricts the cells and vascular system from pouring fluid out and building up pressure, helping to reduce the pain and discomfort. Ice also has an analgesic (pain relieving) effect so you won’t need to spend so much money on paracetamol. 

N.B. The one most important thing to address is the way in which you apply the ice. Please remember to always apply ice through a wet cloth. Ice directly on the skin will burn and using a wet cloth will help to allow the cold to penetrate into the tissues. 

Coupled with Ice is Compression. If at all possible it is good practice to use Ice with Compression because this allows the temperature to penetrate more deeply into the tissues. The compression also aids in restricting fluid loss from the damaged cells.

How long to Ice for? 

An important question to cover in the use of cold therapy is “How long do I Ice for?” This is important because there is an optimal amount of time for this procedure and icing for too long can have the opposite affect to what you had intended. 

Because different areas of the body require different time to ice you can use this simple formula -When the skin turns pale you can stop icing. Any longer and the skin starts to turn red. This is because the body is reacting to the ice in order to stop the chances of frost bite. To do this the body rushes blood to the area, which is exactly what you were trying to reduce with the ice in the first place. 

Once the skin has turned pale, remove the ice and allow the area to return to its normal temperature. When the heat starts to build up once more then crack out the frozen peas again. 

Latest Research

Recent research has begun to challenge the use of ice however, and much confusion has developed as to best practice. Originally RICE protocols were used soon after injury and sustained until swelling subsided. And, although anecdotal evidence from the last 50 years seems suggest this strategy works, it is largely accepted now that you should wait several days before commencing the Ice and Compression elements of RICE to allow the natural repair processes to occur.

At ExerciseLab we suggest waiting 5 days after injury, and if the swelling does not subside, begin to ice the area. This advice is somewhat experimental as the industry begins to test the latest research on a wider population. We take a view with each client to decide if and when to use ice and compression. If the tissues seem to have stalled into an inflammatory cycle then ice will be introduced for 7 days and any changes noted during the follow up appointment. If the injury has a gradual improvement from day one, then we leave the body to heal naturally at its own pace. 

Remember, the profile of the client has a larger influence on healing time than icing once or twice per day ever could. If they have high stress, catabolic hormone profiles, poor nutrition and/or hydration and whether they are capable of resting the injured area are all of higher importance than whether ice was indicated or not. Research is often carried out on otherwise healthy, athletic students rather than over worked, stressed out everyday people, that need to walk 20 minutes to and from work, then sit 8 hours in a chair. Looking at how you can influence these elements with your home care advice will speed recovery enormously.