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The use of ice on a soft tissue injury

 

It’s been a busy few months in the Habit physio clinics with winter and snow sports accounting for many of the soft tissue injuries we treat. Now we’re getting into summer, with warmer, longer days even more people are out being active and exercising. This is brilliant and as a health professional I whole-heartedly encourage this! However, this brings a greater risk of picking up common injuries such as knee or ankle sprains and muscle strains.

According to ACC statistics summer brings a rise in claims, the most common being soft tissue injuries with beach-related activities such as surfing and boating being some of the main culprits. ¹ ²

Cryotherapy (the use of ice) is well-known and commonly used in the management of acute soft tissue injuries. However, this is not always done in the most effective manner and is not always as simple as reaching for a bag of frozen peas.

This article aims to bust some of the myths around the use of ice in the acute stage of an injury and give you the tools and knowledge to optimise your recovery.

What is an acute soft tissue injury?
Soft tissue refers to tissues that connect, support, or surround joints and other structures in the body, including muscles, tendons, ligaments and other fibrous tissues. Any injury to these tissues can result from a sprain, strain or contusion and is considered acute in the first 72 hours. In this stage of an injury you might expect to experience pain on movement, swelling or bruising of the injured area. ³

Why do we use ice after a soft tissue injury?It is a common misconception that ice reduces the swelling associated with an acute soft tissue injury. Research has shown that ice alone will NOT achieve this. ⁴

What applying ice WILL do is decrease the temperature of the injured soft tissue. This has two main benefits:

1. Reducing pain
Applying ice is a great way of providing short term pain relief after an injury. By cooling the skin, you are slowing down the speed that nerves transmit the pain signals from the injured tissue to your brain. This pain-relieving effect will enable you to mobilise and gently exercise the injured area more effectively, which will help to reduce swelling. ⁵

2. Reducing secondary damage to healthy surrounding tissue
After sustaining an acute injury your body triggers an inflammatory response, which is why we experience swelling. This is necessary to help heal the injured cells. However, this can be damaging to the healthy, uninjured cells nearby. By applying ice we are aiming to reduced the metabolic activity of those healthy cells, which helps protect them. ⁴

What’s the best way to apply ice?
While frozen peas and ice packs are useful when nothing else is available (and are often less messy!) crushed ice in a plastic bag applied directly to the skin is best. This will enable the 

skin to be cooled to 10˚C, whereas frozen peas and ice packs will not lower the skin temperature below 13˚C. This doesn’t seem like much of a difference but to achieve the pain-relieving benefits of cryotherapy we need to try and achieve cooling of the tissue to a temperature of 10˚C. Apply the crushed ice for 20 minutes every hour where possible.

Can anyone use ice after an injury?
Cryotherapy isn’t for everyone and is contraindicated for some health conditions. These include:

  • Active deep vein thrombosis (DVT)
  • Areas near a chronic wound eg. an ulcer
  • Raynaud’s disease
  • Impaired circulation 6

For other health conditions, cryotherapy should be used cautiously, and you should discuss this with your Physiotherapist or GP. These include:

  • Cardiac failure
  • Hypertension
  • Areas of impaired sensation
  • Infected tissues
  • Areas of broken skin due to infection risk 6

What else can I do to speed up my recovery?
As mentioned earlier, ice alone will not reduce the swelling associated with an acute injury. In the first 3 days it is important to use ice in conjunction with a few other simple, self-management techniques. To remember these techniques, just think POLICE, which stands for:

PROTECT the injured muscle or joint. The amount of protection required will depend on the extent of the injury  and may involve the use of crutches or a sling initially. The No HARM protocol should also be applied – no heat, no alcohol, no running or strenuous activity, and no massage. This is important in the first 72 hours to minimise bleeding within the injured tissue and reduce the risk of making the injury worse. However, this doesn’t mean you should be fearful of moving at all. Severe pain or an inability to weight bear permitting you should begin to optimally load the injured area. ³

OPTIMAL LOAD simply means you should try to walk and begin gentle range of movement exercise, for example bending and straightening your knee or trying to write the alphabet with your ankle. If you have any concerns with this book in with one of our physiotherapists and they will be able to guide and progress this.

Hopefully you will remember from earlier…

ICE will help to reduce the pain and enable you to optimally load the injured joint or muscle.

COMPRESSION will help to keep swelling at bay when you’re up and about and on the move. This can be as simple as using a tubigrip or compression bandage. If you don’t have this at home most physio clinics or pharmacies will stock them.

ELEVATION of the injured area above the level of the heart will allow gravity to further reduce swelling. Do this little and often in the first 3 days and for an added benefit, this can be used alongside the gentle range of movement exercises mentioned above. When elevating it is important to remove your compression bandage and to slowly return the injured area to a seated or standing position. Doing this too quickly will result in a ‘rebound effect’ where the swelling will drain back towards the injury site, which can be uncomfortable. ⁴

After reading this hopefully you will now have a better understanding of when, how and why to use ice after an injury and what else you can do to speed up the early stages of your recovery. After this it is important to be assessed by a Physiotherapist to help guide the next stage of your rehab and get you back fighting fit!

 

Alex Ormerod is a physiotherapist at Habit Majestic in Wellington.

 

References:

  1. NZ Herald. (2018). ACC details its 440,000 summer claims. [online] Available at: https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11194867 [Accessed 14 Sep. 2018].
  2. FORRESTER, G. (2018). Summertime ACC claims for injuries on the rise. [online] Stuff. Available at: https://www.stuff.co.nz/manawatu-standard/news/88090935/summertime-claims-for-injuries-on-the-rise [Accessed 14 Sep. 2018].
  3. Sports Medicine Australia. (2018). Soft Tissue Injuries | Sports Medicine Australia. [online] Available at: https://sma.org.au/resources-advice/injury-fact-sheets/soft-tissue-injuries/ [Accessed 23 Sep. 2018].
  4. Bleakley, C. (2015). Acute Management of Soft Tissue Injuries. [ebook] ACPSEM. Available at: https://www.physiosinsport.org/media/wysiwyg/ACPSM_Physio_Price_A4.pdf [Accessed 14 Sep. 2018].
  5. Algafly, A. A., & George, K. P. (2007). The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med41(6), 365-9; discussion 369. doi:10.1136/bjsm.2006.031237
  6. Clinical Edge. (2018). Clinical Edge - 5 minute physio tip - Crushing the myths of ice application. Is ice useful for acute injuries and does it reduce swelling?. [online] Available at: https://www.clinicaledge.co/blog/5-minute-physio-tip-crushing-the-myths-of-ice-application-is-ice-useful-for-acute-injuries-and-does-it-reduce-swelling [Accessed 14 Sep. 2018].