Ice is one of the oldest remedies for an injury and still to this day remains probably one of the safest and best. It doesn’t effect your stomach like Advil and Aleve does, and it has the same physiologic effect, if not more. The hard part is getting the patient or injured runner to use it, and also use it correctly!
Even though you may think you’re icing properly, most people don’t do it correctly.
Here’s how to use ice!!
I recommend using a zip lock bag or even a plastic bag from your supermarket. Put about two cups of ice in, or enough to cover the injured area plus a little beyond. When in doubt it’s better to use more then not enough. The key is to get all of the air out of the bag because air can act as an insulating medium. The more air in the bag the less cooling effect the ice can have on the injured region. If you live in a cold region and have access to snow, this works even better because it can conform to the injured body part.
Some will recommend placing a towel between the ice bag and the area of skin being iced. I do not advocate this, but if you have fair skin you may want to. Do you need to? Not really as you will not create frost bite if the ice is melting at room temperature. If you increase the rate at which the ice melts (such as by adding salt) or by leaving the ice on too long, then you could create a burn. The ice bag should be applied under compression usually with an Ace wrap.
How long does the ice need to be left in place? 30 minutes. For the physiologic effect of ice to take place, it needs to be in contact with the injured area for 20 minutes but I always advise 30 minutes. Going beyond 30 will risk frostbite. The first 7 to 8 minutes will be painful at which point the hunting response occurs. This is a vasodilation which increases blood flow and prevents the tissue from freezing. Following these eight minutes your injury area will become numb and will not have pain or burning from the ice. The key is to allow the ice to remain in contact for the first 7-8 minutes. If you keep moving the bag or taking it off reapplying it you will never reach the hunting reaction and you risk frostbite as tissue temperatures will cool to below 2° C creating a burn.
If you were doing an ice massage then the opposite is true. You would only want to perform this massage for approximately 8 to 10 minutes as a hunting response will not occur in the massaging and coldness will take the place of the 30 minutes.
Another option is to place your foot and ankle into a bucket of water with ice. This can be rather painful and mot will not tolerate it. An ice bath should be performed for no more then 20 minutes as the hunting response will not occur and more intense cooling can occur.
Which is better? I guess overall it it depends on the area of your injury. If the area is a deep muscular region which would respond to massage then an ice massage would not hurt. Overall I would recommend constant application of ice for 30 minutes when in doubt.
How often? I tell my patients they can ice every waking hour. Obviously they do not do this (although you’d be surprised, some will!!) but it is safe to ice this often. As injuries become chronic some patients ask if its ok to use heat.
For icing your feet, I was introduced to a product I use pretty frequently known as Icyfeet. After long runs when I’m tired and sore they’re great for quickly strapping on your feet for some soothing relief.
Sometimes it’s difficult to ice the foot or ankle if you have gauze bandages on such as after surgery. In this case I have my patients place the ice behind their knee to cool the blood flow down as it approaches the foot and ankle. Be cautious with this because if it compresses the common peroneal nerve on the outside of the knee (lateral knee) you can end up with a nerve injury which in severe cases can cause drop foot. The bag should be placed directly behind the knee.
So there you have it! That’s how to properly use ice!!
Dr. Campitelli is a podiatrist in Akron, OH specializing in foot and ankle surgery with an interest and enthusiasm for running as well as helping runners with injuries. For the past several years he has been treating running injuries in patients by fixing their form and transitioning them to minimalist shoes. Having treated runners with all types of injuries through conservative measures with orthotics and shoe gear changes to reconstructive foot and ankle surgery, Dr. Campitelli has brought what works best and is most current to his practice as well as the Akron and Cleveland running communities.