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Everything you Need to Know About Icing an Injury

When to Use Ice and When to Avoid It

Cryotherapy is useful for controlling the symptoms of inflammation immediately after a training injury. Cryotherapy’s ability to decrease nerve conduction speed makes it a great tool to relieve pain and reduce muscle spasms. There seems to be a lot of confusion on whether to use heat or ice when dealing with an injury. They both work for pain control, but heat should be avoided for instances of acute inflammation as it increases blood flow which promotes swelling. Cold application on the other hand can reduce swelling. The following are some cautions and situations where you should avoid using ice.

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There are precautions and safety considerations for cryotherapy that you should be aware of:

  1. Before exercise. An athlete or trainer applying ice before exercise can risk further injury for a couple of reasons. One is soft tissue stiffening, primarily in the collagen fibers. If you can imagine what a frozen elastic band will do once you stretch it, the same can be said about your soft tissue when it is cold. Reduced elasticity of muscles and tendons due to cold exposure can increase the risk of a strain while exercising. The other reason is altered proprioception. This is your body’s ability to know where any part of it is in space without needing visual input and it is governed by feedback from proprioceptors. These are nerve receptors that are found in skeletal muscles (muscle spindles), tendons (Golgi tendon organs), and fibrous joint capsules. Sensory nerves decrease in their conduction speed when exposed to cold temperatures, and proprioceptors are no different. To put this into perspective, icing can slow down the nerves that tell you where your body is in space. Colder limbs are more likely to get into risky or incorrect positions while exercising which can increase your risk of injury.
  2. Poor/altered sensation. Use caution when the sensation in an injured limb or extremity is already poor or altered. The loss of intact skin from an open wound can also alter it. Altered sensation can become problematic since the person using the ice may not be able to know or report how well it is working. I have seen good physiotherapists and personal trainers in Mississauga do a quick warm & cold differentiation test around the affected area beforehand to make sure that sensation is intact. If you lack a degree of sensation, you risk overdoing the amount of cold application which can become damaging to soft tissue and superficial nerves. A good way to deal with this is to remove the application every five minutes of treatment. Quickly inspect the skin for any abnormal changes in color and test for sensation.
  3. Hypertension. High blood pressure is a precaution since the vasoconstriction caused by icing can further increase blood pressure. As you can imagine, when blood vessels decrease in diameter, blood must push with a higher driving pressure to achieve the same flow rate. An increase in blood pressure can cause these individuals to feel unwell or faint, so be sure to monitor for these changes.
  4. Children and elders. Younger and older individuals have lower skin integrity and less insulation compared to adults. Ice transfers through their tissue more effectively as a result, meaning they will not require the same extent of cold application.

epa03910744 A stork perches on a stop sign near Immerath, Germany, 15 October 2013, before continuing his journey to search for his favourite food targets – mice, frogs and other small animals. EPA/FEDERICO GAMBARINI


Cryotherapy however, is contraindicated (not to be used) under the following circumstances:

  1. Vasospastic pathologies. These conditions alter the body’s ability to react to cold temperatures. Raynaud’s syndrome, a disorder that affects blood vessels in the extremities (fingers and toes) is an important one to consider. When exposed to low temperatures (even if insignificant), these individuals can experience pallor (whiteness) or cyanosis (bluish discoloration) in the extremities due to a sudden, reflexive reduction in blood flow. This cut in blood flow can become dangerous when sustained for too long.
  2. Cold-hypersensitivity and intolerance. Intolerance typically refers to symptoms of pain, numbness, and/or color changes that are more pronounced and come on faster than normal in response to cold exposure. Hypersensitivity is more of an allergic reaction to low temperatures, and involves symptoms of redness and itchiness.
  3. Impaired circulation. Avoid icing on top of areas of impaired circulation. The body does not have an effective way to manage a hemodynamic response in this area, and you run the risk of tissue ischemia. Cryoglobulinemia and Hemoglobulinemia are two really long names for rare blood conditions that affect circulation and should be considered before icing. The first is a condition in which the blood contains large amounts of a protein called cryoglobulin. When blood temperature drops below 37 degrees Celsius, precipitation of this protein can block blood vessels. Blockage can become significant enough to cause tissue ischemia and gangrene in severe cases. The second condition is related to an interesting reaction to cold exposure. Upon a drop in blood temperature, individuals with hemoglobulinemia will have their urine change to a purple color. This occurs because hemoglobin is broken down and released into the urine.


The risks of cryotherapy include pain, fainting, and frost bite. Fainting is a risk since local vasoconstriction can increase blood pressure, and is more likely to happen in those who already have high blood pressure. Symptoms of pins, needles and tingling can also occur. Cold application should be removed immediately if this progresses to painful tingling or loss of sensation. You can reduce these risks by checking your skin every five minutes, wrapping your gel pack or ice bags with a towel, and applying the pack or bag in a position where it is easy to remove if necessary. If you are using an ice bath for your feet, remove them every five minutes to move your toes around. This will make sure the motor nerves that control their movement are not being affected by the treatment.

Continue to page 5 to read about different methods available and how to use them

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