We all know the basics of ‘RICER” if we sustain an injury – Rest, Ice, Compression, Elevation and Referral – but what is the best way to apply the ice? The main benefit from ice is actually in analgesia – pain relief. We need to reduce skin temperature to between 10 – 15°C to achieve this. Most people believe, or want to believe, that we are doing it to reduce swelling, but to actually change cell metabolism and do this, we need to get a temperature reduction at depth to 5 -10°C, which is not usually possible.

An ice bag filled with crushed ice using wet fabric as a conducting medium is the best way to achieve a quick change in temperature – I use a damp chux cloth around a small freezer bag of crushed ice for ease of use.  If you are needing to reapply, 10 minutes on, 10 minutes off seems to be current best practice – wrap the injured part (eg ankle) with a compression bandage for the 10 minutes off period, and keep alternating for as long as possible.  The rationale for this is that 10 minutes rest will give the skin a chance to recover, but the deeper tissues won’t have warmed back up to normal temperature in that time.  The ice pack also stays colder, so after 30minutes, you have achieved a longer period of cold for the target tissue compared to the more traditional 20 minutes on / off cycle.

Ice is also useful for rehabilitation as the pain relief achieved can help you perform range of movement exercises sooner.

Using the ankle example again, immersing the foot in an ice and water mix (1-4°C) until the foot becomes numb (10 – 20 minutes, after the burning, stinging pain has subsided – unfortunately, I’m serious!), then performing rehab exercises – most often simple range exercises in non weight bearing.  Using ice enables earlier movement and allows the muscle pump action to help remove swelling from the injured area, promoting healing, but is not such a strong analgesic that it will block new pain messages arising from new damage – you aren’t going to go too far with your exercises as a result of ice alone.

A note about instant cold packs – they don’t stay cold for very long.  They may be practical to keep in an emergency first aid kit, but ice is much colder for longer than the gel packs and will result in bigger changes in skin temperature.

Always seek professional advice about your injury – it will help you get back on track quicker and with fewer residual problems.

Article written and supplied by
Tory Toogood, Physiotherapist
Vital Core Physiotherapy
433 Magill Rd
St Morris 5068
8331 0552