When, Why and How to Ice an Injury

The Icing on the Ache: When, Why and How to Ice an Injury
By Olivia Rossi,  RN, MSN, ACSM
Your Personal Trainer,

It might be a tweak.  It might be a gnawing, nagging nuisance.  It might be a sudden twist or tear.  The result is pain, from mild and annoying, to severe and unyielding.  When and how to care for that pain depends on the type of injury it is, acute or chronic.  That in turn determines when and why to apply ice.

First, let’s go over some definitions:

Acute pain is of rapid, often traumatic onset such as an ankle sprain.  An acute injury
usually causes swelling and inflammation.  It often necessitates a trip to the hospital.

Chronic pain develops slowly and is persistent perhaps due to overuse such as chronic
knee or back pain that increases with activity.

Ice is one of the easiest and most effective ways to help the body begin the healing process after an acute injury.  Ice decreases pain and swelling, causes blood vessels to constrict and limits internal bleeding and inflammation to the area.  It is by far the best immediate treatment for an acute injury.  If you sprain your ankle your first two actions should be to STOP and ICE!  This is a good time to talk about an acronym that rhymes with ice and tells you the next two actions that you should take.  The acronym known throughout the exercise world is RICE.  It is an easy-to-remember guide to acute injury care:  Rest–Ice–Compress–Elevate.

REST:  Stop using the injured part as soon as you hurt it.  Believe it or not, people have been told to walk it or even run it off.  Not a good idea.

ICE:  Ice also decreases the speed of nerve conduction, which causes tension or spasms in your muscles to diminish.  The muscles around the injured area relax, helping to decrease your pain.  You can apply ice in several ways–using a store bought soft ice pack, ice in a plastic bag, or even a bag of frozen peas or corn–something that conforms to the injured area.  Place a thin towel, a cloth napkin or a pillow case between your skin and the ice.  Ice the area for 15 minutes at a time, three to four times a day for one or two days.  If the swelling has not improved, consult your physician.

COMPRESS:  Compression limits swelling.  Apply an Ace bandage to the area.  If you feel throbbing it’s probably too tight, so re-wrap it just a little looser.

ELEVATE:  Elevation uses gravity to help drain the excess fluid from around the injury.  It’s better to elevate the injured part above your heart level. For instance, if it’s your ankle, lie down on the couch and elevate your foot on one or two pillows. If it’s your arm, elevate it on cushions beside you. Since swelling begins almost immediately after trauma, begin the RICE process ASAP!

What about a chronic, long-term injury?  Can ice be helpful?  Yes, but in the case of chronic injury such as nagging knee pain or low back pain, ice is better used after an activity.  Apply heat before the activity.  Heat increases blood flow to the area.
Don’t apply heat after the exercise or activity.  After a workout, ice is the better choice for a chronic injury.  Do not apply heat for longer than twenty minutes or leave it on while you are sleeping.  If you’ve ever had physical therapy for a low back injury, you may have noticed that they will apply heat to the area before having you do your exercise therapy and will ice it after.  That is the reason why.

Any injury can be serious and may get worse.  Acute can become chronic and chronic can become debilitating. It can keep you from exercising or even doing your daily activities if you don’t take the time to let your injury heal.  You may need a repeat x-ray or MRI to assess the extent of the injury and the treatment course.  Ice or heat may be contraindicated or used with extreme caution in people with impaired circulation or loss of sensation due to diabetes.

Take care of yourself.  Listen to your body.  Stay active and keep moving.  You may have to take a little time off once in awhile to let an injury heal.  Remember, it’s the long run that counts.

Sources:  ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 7th Edition, 2005
“When to Ice an Injury,” Amber Swedberg,  Pro-Pulse , January–February 2008

Yours in fitness,

Olivia C. Rossi, RN, MSN
Certified Clinical Exercise Specialist, ACSM
Certified Personal Trainer, ACSM

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