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Dos and Don’ts for Icing Injuries
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Dos and Don’ts for Icing Injuries
By Nikki Chavanelle Updated On October 09, 2018
It's the medical recommendation runners get most often. Injured knee? Ice it. Sore shin? Ice it. And it really is good advice—but if you do it wrong, you could damage surrounding muscle tissues, says Joseph Dykstra, M.A., assistant athletic trainer at Calvin College in Grand Rapids, Michigan.
Icing decreases pain and inflammation and enhances healing. This guide will make icing crystal clear, so you can heal faster and get back out on the pavement.
Numbing a body part before running can block signals to your brain that would tell you to back off. This may cause you to alter your gait and form, increasing your risk for injury.
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Whether you suffer an acute injury or have a chronic issue, ice the area as soon as you get home. When applied immediately, ice decreases swelling and initiates healing.
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Don't ice for more than 20 minutes or you'll risk frostbite. If your skin looks red, it's a warning sign you're pushing it. Remove the ice once you feel numbness.
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"If you ice less than 10 minutes, you'll cool your skin, but there will be minimal effect on underlying muscle tissue," Dykstra says. "Fifteen to 20 minutes is ideal."
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An injury benefits from ice in the days following the trauma but one day isn't going to be enough to completely heal. If your symptoms worsen, or if your knee has been nagging you forever, see a doctor.
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To maximize the benefits, ice three to five times a day, with at least 45 minutes in between applications. This keeps tissue temperature low and minimizes inflammation.
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Nikki Chavanelle is one of ACTIVE's Fitness and Nutrition editors. As a former intramural rock star at SMU and current sports junkie, Nikki claims she peaked in college. Follow Nikki on Twitter for fitness and sports chatter.
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Kobe Bryant and Ice: Is It Helping Save His Damaged Knees? | News, Scores, Highlights, Stats, and Rumors
Kobe Bryant Tweeted Out His "Misery"Stephen Dunn/Getty Images
Kobe Bryant tweeted this out last week:
Legs r sore Anyone out there,celebrity or not, care to try this sh*t? Tweet me a pic Misery loves company #assfrozen twitter. com/kobebryant/sta…
— Kobe Bryant (@kobebryant) January 12, 2013
Soaking in an ice tub is no fun, but is it useful?
The medical literature is very mixed on this. First, we must understand the problem. Bryant may not be as old as you think, but his knees are functionally much older. Through both degeneration and the removal of damaged cartilage, Bryant has little functional cartilage inside the knee. His meniscuses are worn down, as is the articular cartilage that overlies the bones (femur and tibia) that hinge at the knee.
Without this cartilage, every step Bryant takes is like a car driving without shock absorbers. Each jump, stop and landing is like a pothole, causing pain and swelling from the bone-on-bone contact.
Bryant has been willing to take on other therapies to help him play. He famously traveled to Germany to undergo Orthokine therapy. Orthokine is a process where a patient's blood is removed from the body, spun in a centrifuge to extract a platelet-rich plasma, then mixed with other substances before being injected back into the damaged area.
The procedure is not unlike PRP injections, which are becoming more common in sports medicine. However, because it is not approved for use in the United States, those that want to try it have to head overseas, lending it something of a dark air.
Bryant has also taken regular injections of lubricant into his knee. The most commonly used one is Synvisc, a dark viscous liquid that at first glance looks like motor oil (Newer formulations look less "refined.").
The purpose is not unlike oil: It is designed to provide some level of lubrication between structures inside the knee. Rather than the cushioning of the natural cartilage, the lubrication prevents the bone-on-bone grinding from causing bone spurs and lesions.
The downside of these type of injections is that they are very temporary. The body absorbs the substance over a matter of weeks, requiring a refill every so often depending on the patient's tolerance. Team doctors have become very adept at timing these injections, often saving them until just before big games.
Since Bryant's medical options are limited, the one thing he can do regularly is try to limit the swelling with ice. Whether it is in bags after the game or in a cold tub like Bryant was pictured, the effect of ice is well known.
Or is it?
There's surprisingly a lot of controversy about how to use ice properly inside the world of sports medicine. On the "pro" side, research indicates that the known effects—reduction of swelling and inflammation, short-term analgesic and some restorative acceleration—are a positive for an athlete, while the therapy itself is inexpensive and nearly universally available.
On the "con" side, there's a much larger body of research. This is largely because they have had to make their case more forcefully. It is common knowledge that ice works, but for an athlete, the effects that it does have in the short term may have longer term consequences.
The use of ice immediately after activity, especially to reduce inflammation such as in a basketball player's knees after a game or in a pitcher's arm after a start, does have some negative effects. The cold may slow the body's natural response to healing, slowing down the recovery. There has also been performance-based research that indicates little actual effect.
Recent research, most famously at the University of Alabama, has been focused on ice baths. While similar to what we saw in Bryant's tweets, the Crimson Tide use ice baths differently. The sports medicine staff sets up several bathtubs filled with ice (On particularly hot days, they do this in a tent just off the practice field).
Players coming off the field will dip in quickly, getting a shock of cold, reducing their core temperature quickly without interfering too much with the inflammatory response. It's an attempt at getting the benefits of ice therapy without the negatives. With the results, it's hard to argue against Alabama's use, though they are hardly the only team to use this.
Proponents will cite Alabama's three national titles, ignoring teams like Kentucky and UConn that use similar therapeutics.
Bryant's (Kobe, not Bear) use of the ice bath is probably something he has done since he came into the league. The cold tub is universal in most training rooms, especially ones run by old-school guys like Gary Vitti, who has been the Lakers' head trainer almost as long as Bryant has been alive.
The tweet was an interesting insight into what Bryant and the medical staff go through to keep him available and as functional as possible. With that said, the look behind the curtain and inside the training room actually tells us very little. Bryant's knees and the Lakers' fate still have a very cloudy future. Until then, Bryant will have more tweets like this:
The tub of youth is calling me tonight! Lol
— Kobe Bryant (@kobebryant) January 16, 2013
How the freezing spray works for football players. The skin hardens up to -50˚, but there is a risk of burns
#medicine #Football
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A common moment in football - after a collision on the field, the player writhes on the lawn. Doctors run up to him and spray the bruise with a spray. The player kneads the bruised place for a couple of minutes and returns.
This spray is called freezing. It is designed to relieve pain from minor injuries.
SVEN SIMON/Global Look Press
It works like an anesthetic, freezing the skin down to -50
The full composition varies by brand, but the base is:
Ethyl chloride.
Butane.
Chloroethyl.
Other substances.
All are used as anesthesia.
Freezing is needed for bruises, sprains, dislocations. After application to the skin, spray causes soft tissue numbness, which prevents the spread of edema . In this case, the cold slows down the flow of blood to the injured area, and internal hemorrhage decreases.
When freezing is applied, skin receptors suppress pain sensations - in a short time the skin cools down to -50 degrees. If the composition of the freeze includes chloroethyl, then it temporarily paralyzes the nerve endings. The main advantage over ice compresses is the speed of action. In a short time (tens of seconds), sprays relieve pain.
How to apply the spray:
1. On the bruised area: either directly on the skin (if not damaged) or through the tissue.
2. 20 centimeters from the damaged area.
3. Less than 7 seconds.
imago-images.de/Global Look Press
It is important to understand that this is not a drug for treatment. Immediately after application to the injured area, the spray relieves pain only for a while. Further - only to the doctors.
Pro cons: risk of burns and hidden injuries
The spray itself is harmless - if used correctly. At the same time, the orthopedist and sports medicine specialist at the Otto von Guericke University in Magdeburg, Dr. Margit Rudolf, highlights several disadvantages:
⏱️ Incorrect (= prolonged) use creates burns. Therefore, Rudolf recommends applying it for only 7 seconds and only at a distance.
〽️ Athletes do not understand what processes are going on under numb skin - this can lead to undetected injuries.
❌ Skin gets used to sprays. The more often you apply, the worse the effect.
imago-images.de/Global Look Press
Rudolf and Andreas Imhoff, professor of sports medicine at the Technical University of Munich, also say that bruises are best treated with ice compresses (their advantage over sprays is their natural properties). Otherwise, they support sports doctors who prevent the development of microtraumas by restoring in cryosaunas.
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❄️ How does it work and why do I need spray freezing? - Underexpert Opinion - Blogs
During football matches, we often see team doctors using freezing spray to relieve the pain of the injured. But how does it work and what are the disadvantages of this method of anesthesia? Let's figure it out.
The main secret is instant cooling
Most of these sprays have approximately the same composition - liquefied gas (propane, butane, isobutane, pentane and others). Sometimes a local anesthetic is also added, but such a composition reduces sensitivity too much, so a regular mixture of gases is more often used.
Their mechanism of action is based on basic physical and anatomical features. The fastest way to cool the body is to evaporate moisture, that is, sweat. With its help, the body removes excess heat, which is produced by actively working muscles. Sweat evaporates slowly enough, which allows you to smoothly reduce body temperature.
In a freezer bottle, gases boil already at a temperature slightly above 0°C, which means they evaporate instantly, taking a huge amount of heat with them and thereby dramatically cooling the skin area in a few seconds.
But how does this help reduce pain?
Everything is quite simple. Such low temperatures slow down all processes occurring in the tissues, practically blocking them. And since pain receptors are close enough to the upper layers of the skin, their sharp cooling slows down the conduction of pain sensitivity and vasodilation, and hence the appearance of substances that cause inflammation and hematomas.
Spray is for symptomatic relief, not cure, and may mask serious injury
Of course, freezing spray has its disadvantages. The first is burns. Yes, a burn can be obtained from exposure to both extremely high and extremely low temperatures. Therefore, the spray should be used with caution, no more than 5-7 seconds and from a distance of 15-20 centimeters.
By the way, contrary to popular belief, it can be used on bare skin, since application through clothing allows you to freeze the area a little longer, but at the same time reduces the effectiveness of the action and does not guarantee the absence of a burn. But on open wounds, the spray should not be used in any case. This will only lead to additional traumatization of this area, but already chemical and temperature. In addition, it will dramatically increase the risk of infection of the wound. It is also better not to use the spray on the skin of the face and head, as it is much more sensitive, and the layer of soft tissues under it is thinner, which increases the risk of burns.
You also need to understand that freezing is needed to relieve the symptoms of minor injuries, such as minor bruises, so as not to remove the player from the match because of such a trifle. But it is not always clear how serious the injury is: sometimes it can turn out that the spray has aggravated the situation, since the player does not feel anything while the freeze is in effect, but at the same time loads the injured area, thereby aggravating the injury.
In addition, pain is only one of the signs of inflammation that occurs at the site of tissue damage. Simply put, pain is just a signal from our body about a breakdown in it. Disabling the alarm does not solve problem . Therefore, if the pain remains longer than 3-5 days after the injury, does not decrease or, on the contrary, intensifies, then this is a reason to consult a doctor. And in general, any pain is a reason to consult a specialist.
What if the injury is more than just a painful blow?
In an ideal situation, a person with a medical education should be present on the field - it is the doctor who determines the severity of the injury, the need to use freezing and the player's continued presence on the field.
If this is not possible, the main danger signals will be the following symptoms: pain did not go away or at least did not decrease after 1-2 applications of freezing, quickly returned or worsened with exercise; edema or hematoma appeared, other symptoms arose besides pain, for example, instability in the injured joint - when you try to lean on, say, the injured knee, the leg is twisted.
In this case, you need to use the universal POLICE protocol - these are 5 basic rules for the treatment of almost any injury.
On the first day after the injury, we protect (Protection) the injured limb, completely unloading it with the help of crutches, an orthosis or other similar means, since we do not have a diagnosis and treatment tactics. This is necessary so as not to aggravate the current injury.
When we already know the diagnosis, the period of optimal loading (Optimal Loading) begins - a load that is adequate for this stage of rehabilitation. The fact is that complete rest not only does not heal, but also harms.
As a former intramural rock star at SMU and current sports junkie, Nikki claims she peaked in college. Follow Nikki on Twitter for fitness and sports chatter.
com/kobebryant/sta…
The cold may slow the body's natural response to healing, slowing down the recovery. There has also been performance-based research that indicates little actual effect.
Doctors run up to him and spray the bruise with a spray. The player kneads the bruised place for a couple of minutes and returns. 
The main advantage over ice compresses is the speed of action. In a short time (tens of seconds), sprays relieve pain. 
Sometimes a local anesthetic is also added, but such a composition reduces sensitivity too much, so a regular mixture of gases is more often used. 
