Most people’s immediate thought after an injury is to apply ice. And this is in fact a good idea and I’ll explain why. As an aside, heat is certainly not recommended in most cases following an acute injury. I liken it to adding heat to a fire that you want to put out. The reason I say this is because inflammation, which translates as “a setting on fire” in Latin, is the main response that the body implements following an acute injury. Instead, we’re usually better off adding ice or cold to that heat or “fire”.

An acute injury will result in damage and/or death of the tissues involved. These tissues usually include blood vessels or capillaries (the smallest blood vessels), ligament, tendon, muscle, lymphatic vessels, bone, and/or skin. The location of the injury will certainly determine which tissues are involved. Essentially, the application of ice is to help slow the damage caused by the injury in order to allow for more efficient healing and less pain in these tissues. [Please keep in mind, the type of acute injury I’m referring to in this article is one in which there is NO external bleeding and the skin has NOT broken.]

The purpose of applying ice is obviously to lower the temperature of the tissues. This, in turn, will slow the metabolism that’s taking place as a result of the injury. The result is a decrease in swelling, pain, bruising, and inflammation. The cumulative results of applying ice properly and timely should ultimately result in a decrease in cell damage and death, and a speeding of the healing process.

One important effect of applying ice is vasoconstriction, or a constriction of the blood vessels. This helps control internal bleeding as well as bruising. However, there is a phenomenon known as the hunting reflex. This occurs when ice is applied to an area for too long. Theoretically, when this happens, the body will sense that the prolonged exposure to cold will cause tissue damage because of the lack of blood flow. As a result, the body will respond with a reflex vasodilation to prevent damage. Thus, an application of ice for too long a period of time will actually cause the opposite response of what it is intended to accomplish.

So how long is too long? Most literature on the subject says ice should be applied for 10-20 minutes an hour at a time. In my personal experience and experience with patients, I find that 10 minutes works best. Additionally, most literature says that ice should be applied for 2-4 times per day for the first 3-4 days after an injury. I personally prefer 4 times a day.

In conclusion, the research on the best application of ice after an injury varies. Again, what I find most useful is a 10-minute application of ice, four times a day, while waiting at least an hour before subsequent applications.

Please note that a layer of cloth should be used between the ice and the skin to prevent damage to the skin. Also, ice is generally recommended for acute injuries (up to 72 hours); although it may also be appropriate to apply ice after an exacerbation of a chronic injury.

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Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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