Dr. Chris: What's the deal with ice? Can it really help me get back to running after hurting my hamstring in a Turkey Trot last week? I've been icing as much as possible (30-40minutes at a time) a few times per day, and it doesn't seem to be helping...
-Jim (Chicago, IL)
Jim: I'm sorry to hear about your hamstring. Be patient though, and you'll get back. Sadly nothing heals instantly. There is moderate evidence to suggest that the ice can indeed help you, though. The application of cold to injured tissue, or cryotherapy, has been shown to reduce pain,1-3 and more importantly, reduce the amount of time before returning to former activity.3, 4 However, as with so much of the health industry, we keep learning more and more about how best to apply various methods of healing. In the case of cryotherapy, this means that we have narrowed down the duration of application, and it is far less than most people think. 10 minutes is all you need.
Most of the temperature change occurs during the first 10 minutes of icing, though while you can get a bit more going from 10 to 20min,3 icing for longer than 10 minutes may lead to nerve damage in superficial nerves and, of course, frostbite. Additionally, for a re-warming period of approximately 30 minutes following cryotherapy, impairments to both motor function and reflex activity have been noted.3 Thus it becomes prudent to take it easy for the 30-minutes after you ice (i.e., no exercise, stretching, running across the street, etc).
The best material to use for cryotherapy is crushed ice wrapped in a wet towel.3, 5 However gel packs and frozen vegetables will also work to reduce tissue temperature.5
- Ideal Application 1-4:
- Apply ice(*) for 10 minutes
- Remove for 10 minutes
- Reapply for 10 minutes
- Repeat this cycle once every 2 hours (4-5 times per day)
- Less ideal, but better than nothing:
- Apply for 10 minutes every 2 hours (4-5 times per day = if possible)
Good luck!
References:
1. Bleakley CM, McDonough SM, MacAuley DC, Bjordal J. Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols Br J Sports Med. August 1, 2006 2006;40(8):700-705.
2. Hubbard TJ, Denegar CR. Does Cryotherapy Improve Outcomes With Soft Tissue Injury? J Athl Train. Sep 2004;39(3):278-279.
3. Mac Auley DC. Ice therapy: how good is the evidence? Int J Sports Med. Jul 2001;22(5):379-384.
4. Hubbard TJ, Aronson SL, Denegar CR. Does Cryotherapy Hasten Return to Participation? A Systematic Review. J Athl Train. Mar 2004;39(1):88-94.
5. Kennet J, Hardaker N, Hobbs S, Selfe J. Cooling efficiency of 4 common cryotherapeutic agents. J Athl Train. Jul-Sep 2007;42(3):343-348.
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Dr. Chris Ramsey (physical therapist, triathlete, and coach) fields questions from our readers to provide insight on a range of topics including injury rehab and prevention, training, and racing.
