Putting Injuries on Ice

Despite best efforts, injuries to soft body tissues like muscles (strains and contusions) and ligaments (sprains) are often unavoidable.  Though painful, minor injuries do not always require a trip to the doctor's office, however it is essential to properly manage these injuries at home. The "RICE" (Rest, Ice, Compression, Elevation) principle is the most common method for treatment of minor injuries.  The acronym "RICE" is an easy way to remember the four basic methods used to speed minor injury recovery.

Rest or Restricted Activity
Rest the injured area.  This does not mean activity has to be ceased completely, just avoid any movement or activity that may further aggravate the injured body part.  This allows adequate time for the repair and healing processes to take place.  Prolonged rest and inactivity can result in muscle atrophy and specific degeneration surrounding the injury site.  The athlete should be encouraged to move the joint or limb in a pain free range-of-motion.

Ice
Ice the injured area.  Ice decreases inflammation, swelling and bleeding by causing vasoconstriction, which reduces blood flow to the injured site.   Pain and muscle spasm are decreased directly by the effect of ice on pain receptors and nerve conduction (thus providing an anesthetic effect).

Ice should be applied for 15-20 minutes at a time, allowing approximately 40-60 minutes between applications.  Icing time should be reduced to 10 minutes for the hands, face, neck, groin, and the lateral aspect of the knee, as the underlying soft tissues are more superficial and cool down more quickly. 

Various applications of cold and their respective advantages and disadvantage are summarized below.   For those who are unable to tolerate the cold ice bag on their skin, soak a single thin layer of cloth (i.e. tensor bandage, sock, or towel) in cold water, place it over or wrap it around the injury site and place the ice over top.  Wet material will transfer the cold from the ice much more effectively than dry material.

IMPORTANT: Do not use ice over the heart, spine, vital organs, eyes or large scars. Do not use ice on individuals with diabetes, rheumatoid arthritis, lupus Raynaud's disease or allergies to cold.

Compression
Applying gentle compression (tensor bandage) to the injured area to help reduce swelling.  Compression is more important than ice application in the management of musculoskeletal injuries.  Compression should be continued throughout the day, as long as swelling is present. Note, the compression bandage should be removed at night.

Elevation
The injured area should be elevated above the level of the heart to reduce internal bleeding and swelling, facilitate venous return, and prevent the pooling of fluids in the injured area.  Elevation should be maintained as long as the injured area has swelling present, even at night.

Methods of Cold Application

Ice Bags

Application:

• Place crushed (or cubed) ice in plastic bag

Advantages:

• Inexpensive
• Efficient
• Convenient

Disadvantages:

• Bags can leak and create a watery mess
• Does not contour to body parts

Ice Massage

Application:

• Freeze water in small paper cups
• Peel cup back to expose ice apply to injured area in a circular motion

Advantages:

• Little risk of skin damage (frostbite) because of continued motion

Disadvantages:

• Requires refrigeration until the moment of use

Ice Immersion

Application:

• Place ice in cold water and immerse affected area (5-15 minutes)

Advantages:

• Injured joint is in complete contact
• Can do range of motion exercises in bucket

Disadvantages:

• Sometimes uncomfortably cold
• If ice is used in a whirlpool, swirling action may lower water temperature enough to increase the risk of frostbite

Ice Towels

Application:

• Dip a terry cloth towel in bucket with crushed ice and water
• Ice crystals stick to towel place over injury site

Advantages: 

• Can be placed over larger surface areas

Disadvantages:

• Must be changed often (every 4-5 minutes) due to rapid warming of towel

Gel Packs

Application:

• Store in freezer

Advantages: 

• Reusable
• Contours to body part

Disadvantages: 

• Expensive
• Do not cool as effectively as other methods

Chemical Packs

Application:

• Shake or bend contents of package

Advantages:

• Do not require refrigeration

Disadvantages:

• Expensive
• Do not cool as effectively as other methods
• If contents of pack leak can lead to skin burn

Cold Spray

Application:

• Spray area at a distance of approximately 60 cm (2 feet)

Advantages:

• Convenient

Disadvantages:

• DOES NOT bring about any decrease in subcutaneous tissue temperature

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