Physically
Centered

By Ryan Iverach, DC

Dr. Ryan Iverach is a graduate of Western States Chiropractic College and is licensed in the state of Oregon as a Doctor of Chiropractic. An accomplished endurance athlete and Ironman Triathlete, Dr. Ryan has taught at Western States Chiropractic College and is a Chiropractic Physician at Pure Motion Chiropractic. Contact Dr. Ryan Iverach at 503-640-6404: email
drryan@puremotionchiropractic.com

A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world.
— Paul Dudley White

All About Applying Ice –
Why, When, and How?

“Looks like you’ve sprained your ankle,” states the chiropractor. He leaves the room, only to return carrying a medium-sized ice pack. After loosely wrapping the ice pack around the patient’s swollen ankle, he elevates the patient’s legs and places a cushioning roll beneath them. “We’ll take that off in about 15 minutes and get you on the road to recovery,” are his final words.

The practice of applying ice to an area has its origins with the early Greek and Roman physicians. Cold applications of snow and natural ice were used to treat a variety of medical ailments hundreds of years ago, but it was not until 1835 medical physicians began to routinely use ice compresses for aiding in wound healing. During the 1940s, icing athletic injuries and other musculoskeletal injuries began to be common practice, and this has continued to the present day.

When muscles and connective tissue are first injured, there are a few physiological processes that begin to happen. First, the area may bleed a small amount depending on the severity of the injury. The bleeding and damage to the tissue set off a cascade of chemical reactions, with the end result of edema (swelling). As the area swells, the blood and oxygen supply to the surrounding tissues becomes compromised. At this point, the cells in the immediate vicinity (although not injured in the original accident) become vulnerable to a process called secondary hypoxic injury, whereby they begin to die from a lack of oxygen due to the compromised blood supply.

Of course, the body has its own mechanisms for dealing with these processes, but applying an ice pack to the injured area is one of the best ways to help your body deal with an acute injury. By cooling damaged tissue, ice causes several reactions that help to speed healing. The rapid decrease in temperature causes the local blood vessels to constrict, and this decreases swelling. Less swelling means less pressure, and that equates to a decrease in pain sensation. The sensation of cold also helps to override the sensation of pain, and gives relief.

As the temperature of the tissues drops, so too does the metabolic rate of the cells that make up that tissue, with the result being that the cells require less of the already limited blood and oxygen supply they are receiving to stay alive. This limits the amount of tissue damage due to secondary hypoxic injury, and creates a healing-friendly environment as soon as possible.

A variety of methods exist for icing an injury, but whether it’s crushed ice, shaved ice, a commercial gel pack or (Mom’s old stand-by) a bag of frozen peas, the most crucial element is that the area gets ice soon after the injury occurs. If ice is going to make a difference with respect to recovery time, it needs to be applied within the first 48 to 72 hours after the injury takes place. To do this, lay a tea towel, T-shirt, or sock (depending on the area) over the injury site and then apply the ice. Using a wrap to secure the ice in place is helpful for applying compression to the area, but be sure the wrap is loose enough to avoid stopping blood flow altogether. Elevating the area is also helpful for limiting swelling. Leave the ice on for 15 to 20 minutes and then allow the tissues to warm up to normal temperature over the next hour — making a total treatment time of about 80 minutes.

Placing a barrier (such as the tea towel mentioned above) between the ice pack and the skin helps to decrease the chances of frost nip or frostbite. It is not a good idea to use a wrap with a commercial gel/ice pack, as the gel is capable of becoming much colder than ice, and frostbite could be an issue. Limiting the “ice time” to 15 minutes is the best way to prevent the area from becoming too cold.

For those who want an alternative to the traditional ice pack, an ice bath is always an option. This depends, of course, on the body part needing to be cooled. With walkers, it’s usually a lower leg, ankle, or foot. If this is the case, start by filling a bucket with cold water, then add in the ice. Next, take a deep breath and plunge the foot into the cold water. Using this method, 10 minutes should suffice to bring the foot temperature down. If you finish your walk near a river or lake that you’re comfortable putting your tootsies in, then roll up your pants and head into the water barefoot for up to 10 minutes. This is usually very refreshing even if you’re not dealing with an injury.

If finding time to ice an injury is a problem, plan ahead and have the ice and other supplies waiting in the car at the end of a workout. Stretch out for 10 minutes, and then apply the ice for the drive home. That way arriving home means the workout is finished, and the injury has also been addressed.

An easy way to remember all the details of icing is to keep the word RICE in mind. It acts as an acronym for Rest, Ice (for 15 to 20 minutes, followed by a full hour of no ice), Compress (with a wrap), and Elevate (above the heart). These are the four key components to remember for the next time your body needs a hand with healing an injury.