To Ice or Not to Ice?

Here’s some advice for management of acute (just done it!) soft tissue injury. (muscles, ligaments, tendons)

~ What happens when you damage soft tissue? e.g. pull a muscle, sprain an ankle

~ What’s best to use, heat or ice?  –  my mate told me to do both

Ok, you’ve just stepped in a rabbit hole out dog walking and think you’ve sprained your ankle, or you’ve gone for a lunge shot in tennis right at the end of the game and felt a pop/tear in your calf muscle and now can’t walk…

What’s happening?

1.   Torn soft tissue causes damage to the small blood vessels, capillaries and leads to bleeding – often you will see a bruise after a day or so – this is also the result of bleeding. There is an initial increase in pressure in the tissues and decrease in oxygen available at the injury site. This causes hypoxia to the tissue and surrounding area, meaning it is starved of oxygen and alerts your pain receptors

Woman runner got sports injury running on forest trail

There now begins 3 further phases of tissue healing, the different phases are not clear cut and overlap each other. This is why we often say it will take approximately 6 weeks or so for physiological healing to happen.

2. Inflammation – An instant response following trauma and causes a vascular response (vasodilation) leading to oedema (swelling). A cellular response also occurs, removing dead cells and debris at the injury site and this initiates the beginning of the healing process, proliferation!

3. Proliferation – Lays down replacement collagen or scar tissue and will begin after a day or two following the initial injury and will peak around 2-3 weeks following injury. The amount of scar tissue deposited depends on the type of tissue injured.

4. Remodelling – This phase is often overlooked but is crucial to the healing of the tissue. At this stage the collagen fibres are orientated and reorganised. Scar tissue has to be modelled and manipulated to avoid weak tissue fibres (A weak spot in the tissue) due to random orientation. It is easier to manipulate and orientate a maturing scar and therefore create a more robust arrangement and structure. This can take up to 18 months to complete!!

What’s best to use, heat or ice?  

If you have an injury where you suspect you have torn something and there may be bleeding and swelling, we recommend ICE for the first 24-72 hours – this is because ice causes a degree of vasoconstriction, tightening the small blood vessels and stopping so much bleeding and this in turn causes less damage to surrounding tissue and less hypoxia.

Ice also has a good pain relief or analgesic effect and you’ll want that!

On the first day, you may want to ice every hour but only for 10-15 minutes as cooling the tissue too much doesn’t help (I know, it’s never straight forward) so we recommend a gel pack from the freezer or good old frozen peas, wrapped in a damp tea towel and placed over the site of injury for 15 minutes max.

With a new injury, if you’re in doubt as to what you’ve done we would always recommend try ice for the first 24 hours – why? Well, let’s talk about heat – putting heat on an area will open the blood vessels (vaso dilation) and allow more blood to flow more freely – if you are trying to stop bleeding in a tissue this is not a good idea.

BUT, a couple of days or so down the line when the bleeding phase is done, heat may be just the thing to relax your muscles and improve circulation to remove toxins (waste metabolites and cytokines) and decrease pain and tension.

Heat can also help with pain relief. It’s great for say acute back or neck or hip pain when you’ve overdone gardening or sport, and not actually torn anything. The evidence suggests heat is probably better in these situations, overuse, fatigue, muscle soreness…

What about hot then cold as a treatment – well there’s not a lot of evidence about this way, but we do sometimes recommend it for a foot or hand injury when you can put the whole hand in a bowl of ice for as long as you can stand and then put it in a bowl of warm water to relieve the pain from the ice! It may be worth a try but again follow the initial advice of ice pack for first few days if you’re not sure what you’ve done.

If it feels HOT, apply COLD and avoid HEAT and FRICTION. This prevents further pain and tissue bleeding.

POLICE your acute injury (Protect, Optimal Loading, Ice, Compression, Elevation)

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