Excessive “Icing” should only be called in hockey
My experience of working in numerous medical offices was that the prevailing practice at the end of each treatment is to provide an icepack. In cases where someone was recovering from recent surgery, I did not question this too much. However, I soon began to realize that I was involved in a very indiscriminate practice where almost all injuries, regardless of the severity or chronicity, followed this standard. Patients expected that this was the appropriate choice of treatment and it would have been difficult for me to go against the flow of my colleagues.
With a simple search online, there’s ample evidence that ice is indeed a good anti-inflammatory agent used to stop bleeding and reduce pain. However, it is over utilized and should really only be used in the initial stages of injury if necessary.
Here is an excerpt from Mayo Clinic online. “When you’re first injured, ice is a better choice than heat. It numbs pain and causes blood vessels to constrict, which helps reduce swelling. Ice is especially helpful for the first three days or so. After that, heat can increase blood flow to an injury, which may help promote healing. Heat also serves as a muscle relaxer, which can help with pain relief.”
This article simply states the differences between heat and cold but doesn’t offer any alternatives to traditional benefits of ice and anti-inflammatory treatment.
So what are the other options and why is over icing a serious matter you should question for your own injury and preventative care.
Things need to move to heal.
As far as injuries go, the “freezing” and constricting of blood vessels and soft tissues, thereby inhibiting normal circulation being restored to the injured area, comes at a high price during the healing phase. The blood and fluids in the area are unable to move, becoming hardened and contracted, and make it that much harder for the fluids and blood to disperse in the future. This over icing may then contribute to many cases of ankle or knee sprains that retain some degree of swelling well into the future.
Just keep your frozen foods on ice. You are alive!
As a case in point, I present to you a runner I met who suffers from sub acute Achilles tendonitis. I saw this patient several weeks after his initial complaints began. Inspection of his lower calf and Achilles showed near frostbite like symptoms of his skin. He admitted to being too vigorous in icing the Achilles area due to his pain, which ironically gave little to no relief.
The culprit, tendon and muscle injuries.
In cases of acute muscle or tendon tears that don’t require surgery, you can apply intermittent ice packs for 15min in duration. I usually advise just doing this in the first 48 hours to decrease bleeding and reduce pain.
In a subacute or chronic injury, weeks or months past initial strain or onset, tendonitis is often the culprit. Tendons are bands of fibrous tissue that connect muscles to bones and tendonitis usually occurs when repetitive motions, stress or repeat injuries cause irritation over time. The result is pain and swelling in the tendons around a joint, such as your ankle, elbow or shoulder. Your tendons become less flexible with age, and can be affected by poor posture and joint mechanics. As a Masters runner and future member of AARP, I am aware of the effects of chronic cold on the joints and no longer question why people would seek out warmer winter homes. However, if moving to Florida isn’t an option, seeking some other forms of therapy are.
Sample treatment plan:
The treatment for my patient with Achilles tendonitis consisted of postural correction at his ankle and arch, foam rolling out his calf muscles, acupuncture and massage to his calf muscles and Achilles region, as well as stretches throughout the hip and leg. The last part of the treatment was education on applying an herbal poultice to the lower Achilles’ tendon insertion.
I have had a number of patients respond very well to “herbal ice” applications which come in several types depending on the stage of healing you are in.
Contact me if you are interested in more information about recovering from injuries or prevention with acupuncture or physical therapy treatment.
– Russell Stram PT, LAc.
Runner Clinic NYC
Acupuncture & PT
This post is the opinion of the author and does not necessarily represent the opinion of the Dashing Whippets Running Team, its board, or its captains.