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The Big Chill Part 1: Cold Therapy for

Injury Recovery

What to do in the early stages of a muscle injury.


As you can imagine, I see a lot of people hobbling into my clinic that have suffered some kind of injury and I’m always amazed at how these clients go about basic injury First Aid. By far the most important part of any strategy to recover from injury is what you do in the first 72 hours so this article is going to cover the best practice.


Muscular injuries come in many forms and often it's hard to place your finger on exactly how you came to be in such acute pain. There are the obvious times when you are partaking in some kind of physical activity and you suffer a debilitatingly sharp pain which inhibits you from taking another step, and there are the other days where you struggle to understand quite how you came to hurt yourself. Either way you are now in the Acute stage of injury.

The Acute Stage.


At this time you are at the most critical point. You need to make a decision as to what you can do to deal with this injury. Do you ignore it and hope it will go away in a couple of days? Do you go and relax in a nice hot bath? Or do you brave the spine chilling sensation of placing a bag of peas on your injury?


I ask these questions of my clients all the time and it's always interesting to hear their response. “Its the middle of winter and I couldn’t face putting ice on it so I got the hot water bottle out instead and it seemed to ease the pain just as well”. Or, “I left it for a few days and the pain turned into a constant ache so I used some Deep Heat to ease it but nothing seems to be working”.


Heat has the effect of increasing blood flow to an area, and therefore increasing the pressure and more importantly the metabolic rate of the tissues. This increase in metabolic rate is hugely damaging to the tissues around the injury site making the recovery time longer. The original area of injury that needed to repair grows larger as this increased metabolic rate damages more cells. Oddly, heat generation is a natural part of the body’s reaction to injury and it is only by taking conscious action to cool it down do we get the best recovery.


This is where Ice comes into play. Ice is part of the basic first aid protocol known as P.R.I.C.E. standing for Protect, Rest, Ice, Compression, Elevation. Depending on the type of injury the use of each of these treatments is more or less important but the two that are always used are Ice and Compression.


Let's start with Ice. Ice by its very nature cools the affected site and therefore reduces the heat generated by the body. This cooling effect reduces the metabolic rate and restricts the cells and vascular system from pouring fluid out and building up pressure, helping to reduce the pain and discomfort. Ice also has an analgesic (pain relieving) effect so you won’t need to spend so much money on paracetamol.


N.B. The one most important thing to address is the way in which you apply the ice. Please remember to always apply ice through a wet cloth. Ice directly on the skin will burn and using a wet cloth will help to allow the cold to penetrate into the tissues.


Coupled with Ice is Compression. If at all possible it is good practice to use Ice with Compression because this allows the temperature to penetrate more deeply into the tissues. The compression also aids in restricting fluid loss from the damaged cells.

How long to Ice for?


An important question to cover in the use of cold therapy is “How long do I Ice for?” This is important because there is an optimal amount of time for this procedure and icing for too long can have the opposite affect to what you had intended.


Because different areas of the body require different time to ice you can use this simple formula - When the skin turns pale you can stop icing. Any longer and the skin starts to turn red. This is because the body is reacting to the ice in order to stop the chances of frost bite. To do this the body rushes blood to the area, which is exactly what you were trying to stop with the ice in the first place.


Once the skin has turned pale remove the ice and allow the area to return to its normal temperature. When the heat starts to build up once more then crack out the frozen peas again.


One thing I hear a lot is “I did it yesterday so I thought it was too late to ice it now”. I don’t know where this advice came from in the first place but it is never too late to use Ice. If there is excess heat then you are good to use Ice - Simple! Use the Ice treatment for however long it takes for the body to stop generating excess heat. This could be 48 hours in the the case of a minor injury or it could be 8 weeks if you’ve just had knee replacement surgery. Either way use the Ice and Compression for as long as it takes. The important thing however is to start mobilising the tissues as soon as you can. And this will be the topic of our next discussion.



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