Acute injury treatment—how to use ice and compression – Brief Article

Rest, ice, compression, and elevation, or RICE, is the gold standard for treating acute soft tissue injuries. Rest and elevation require no explanation, just common sense. Ice and compression, however, can seem perfectly straightforward only until you need them, and then a host of questions arise-how do you apply it, how long, how often, how much ice, chemical ice or ice cubes, wet or dry? Can you overdo it? Here is a quick study of the use of ice and compression for the treatment of injury based on information in several published reviews of the medical literature.

Why Cold and Pressure?

Traumatic injury can cause bruising, bleeding, inflammation, and pain. Swelling can cause additional damage to tissues by squeezing out circulation and consequently, oxygen. Reducing swelling reduces recovery time and cold therapy reduces swelling, along with pain, inflammation, and bruising. Applying pressure can also minimize swelling. Using ice and compression together as soon as possible after an injury can help to improve recovery and help you feel better in the meantime. Overuse injuries also benefit from cold therapy.

The Caveat-Yes, You Can Overdo It

While lowering the temperature of injured tissues initially reduces blood flow and edema (swelling), using cold for too long and lowering the temperature of tissues too far can cause the opposite effect. Prolonged cold therapy can increase the permeability of the lymph vessels allowing extra lymph fluid to seep into injured tissues resulting in additional swelling.

When to Use Cold Therapy

The sooner you get ice on your injury the better. The longer the delay, the more swelling, bruising and inflammation you will endure, and research suggests that delaying can result in longer recovery times. Using ice therapy for only 15 to 20 minutes chills the tissues without the risk of tissue temperatures getting low enough to risk additional swelling from the cold or damage from freezing. The 15- to 20-minute treatments should be repeated several times a day for the first few days. Repeat as often as once every two hours. After swelling is gone, use ice to help control pain.

Remove It to Cool It

When you apply ice to an injured body part, only the very outer tissues are cooled at first. Deeper tissues (most likely the injured ones) cool down after you remove your ice pack. A recent study of the heat dynamics of ice therapy measured the temperatures during and after ice treatment at one, two, and three centi-meters below the skin surface. When ice was applied, the surface tissues cooled rapidly while temperature at depths of two and three centimeters were unchanged. After the ice was removed the measurements reversed-the deeper tissues give up heat (get cooler) as the surface warms up. The deep tissues remained cooler for up to 40 minutes after the ice was removed.

How to Apply Ice and Compression

There are many effective ways to use cold therapy and compression, but the most commonly recommended may be the best. First cover the injury with a damp cloth. Partially fill a plastic bag with ice and then suck the extra air out of the bag. (Extra air in the bag will insulate your body from the cold.) Then place the plastic bag with ice over the cloth. Finally wrap the ice gently with an ace bandage. This will provide gentle compression as well as cold therapy.

Chemical ice packs can be great to carry in your gym bag or car for use when you don’t have access to ice, but good old frozen H2O is your best bet (and a whole lot cheaper). If you use a chemical ice pack, be sure to put something between it and your skin. Avoid “mineral ice” preparations that cool with an alcohol-based gel. The alcohol evaporates making the skin feel cool, at the same time causing dilation of the surface blood vessels and, consequently, promotes swelling.

Call Your Doctor

You should see your doctor for any significant or persistent injury, but what you do in the first hours after an injury (before you get to your doctor) can make a big difference in how fast you heal and how you feel in the meantime.

(Medicine and Science in Sports and Exercise, 2002, Vol. 34, No. 1, pp. 45-50; American Journal of Medicine and Sports, 2001, Vol. 3, No. 3, pp. 166-170; Clinical Journal of Sports Medicine, 2001, Vol. 11, No. 2, pp. 67-72; International Journal of Sports Medicine, Vol. 22, No. 5, pp. 379-384)

COPYRIGHT 2002 American Running & Fitness Association

COPYRIGHT 2003 Gale Group

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