Ice Everything

swollen ankleA friend of mine recently messed up his ankle pretty bad during a basketball game.  His first questions was will he be able to play next weekend?

As an athletic trainer this is the most common question you get from the player, the coaches and sometimes even the press.

There are a lot of tests, procedures and understanding that go into making the return to play call.  However with any minor and some major injuries there are a few things you should do.

RICE rest ice compress elevateIf you haven’t heard the term RICE, then let me be the first to throw that out there for you.  Rest; Ice, Compress, Elevate. I will be mentioning all of these activities, but focusing on icing.

Rest: Rest is used to break up the pain-spasm cycle.

Compression: This is a mechanical way to push the inflammation out of the area so your body can get rid of it.

Elevate: Elevate is similar to compression, especially in the lower body.  The venous return, how the blood gets back to the heart, only works when our muscles contract and squeeze the blood back up the body.  So, if you are hurt and can’t move then you need another way for the blood to get back to the heart, elevation!

Ice

melting iceIce is AWESOME.  One of the best things about ice is it is fairly abundant.  It doesn’t matter if you are in the park or in a full on gym the odds are someone close has ice with them, even if you need to steal it from someones soda!

During the injury process a cell breaks open like an egg.  During this process it releases chemicals, proteins and everything it has out into the body.  When this happens the body responds by trying to fix it.  Because the body is trying to fix itself as fast as possible it throws everything it can at the injured area.  During this time other cells that were near the first injured cell start to break open because of the influx off all that healing elements.  This is known as Second Cell Death Syndrome(SDCS).

Random factoid, in many spinal injuries where the spinal cord was not injured, but the structures around the cord were, result in paralysis because of Second Cell Death Syndrome effects.

visocity of liquidThis SCDS needs to stop as soon as possible.  ICE is how we do this.  When you ice the area that is hurt you slow down the viscosity of the blood in the area.  Meaning you slow down the rate at which blood gets there.  Well, if all these helping cells were slowed down in their pursuit to help, then we can also slow down the rate at which SCDS happens.

The other great benefit from ice is it is cold!  Yup hold it on there for a while and it goes numb.  This breaks up the pain-spasm cycle, by not allowing pain.  So if you have no pain then you also prevent the helping cells from even needing to get there in the first place, then SCDS doesn’t occur and you start preventing swelling.phase change

Use Ice vs. Ice packets if at all possible.  What makes ice so effective is a term called a phase change.  This is the process of when ice turns to water. It takes a lot of energy, heat is a measurement of energy, to make this change happen.  This means that the area cools down much faster than if you were to use an ice pack, even if the ice pack is actually colder, which is pretty common.

Important Things To Note When Icing

timeIce has a delayed effect.  This means that it works long after you have applied the ice.  For example, if you ice your quadriceps muscle for 20 minutes and remove the ice, the chilling effect of the ice will actually penetrate deeper over the next hour.  This means DO NOT run around after you ice.

You are still getting the effect from he ice so use it.  Once you start moving around, take a shower, or even start wiggling your foot, you start bringing more blood to the area.  This movement rapidly heats the area, trying to bring it back to normal.  We do not want this as we are trying to keep the pain-spasm cycle under control as well as limit the amount of inflammation that is going to occur.

slush bucketThe colder you can take the ice the better.  For ankle injuries I really like using a slush bucket.  This is when you fill a bucket full of ice and add enough water to make it slushy.  Once you out your foot in the water, which will be FREEZING do to the phase change, keep it moving.  If you leave it in one place you will develop a thermal bubble around your foot and decrease the effect of the ice treatment.

In closing, use ice.  Start with it and keep using it.  Heat is bad and should not be used EVER when you trying to prevent inflammation.  Is as much as you can as often as you can, if you are really trying to prevent inflammation.  If you have to walk around then ice more.  Icing should not be based off of time, but based off how long it takes the area to go numb.

Let me repeat that:  Ice until you are numb, not for a time!

If you have any questions about using ice for treating your injury feel free let me know.  I can also give you some exercises to do in a slush bucket to help you recover faster.

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