In order to know when to ice and when to refrain from icing, it is important to understand the healing process. After an injury, the human body goes through natural responses to help protect the site of injury. These responses are:
- Hemostasis (Exact moment of injury; stoppage of blood flow due to injury hemorrhage)1
- Inflammatory (Few minutes to 2-3 days from injury; body sends reinforcements, such as macrophages, to protect the area)1.
- Proliferation (~3days after injury to few weeks; tissues begin to heal with scarring and collagen to strengthen the injury site)1
- Remodeling (Few weeks to a year-plus; advanced tissue healing, which includes advanced tissue fibers over the site then complete tissue healing)1
- Slightly decrease muscle regeneration (which further weakens the muscle and its ability to rebound back to a pre-injury state.)3,4
- Decreases cellular metabolism needed to advance the healing stages (Satellite cells and white blood cells are needed to decrease inflammation and eliminate debris from the injury site.)3,4
- Muscle stiffness (which decreases elasticity hence decreases the range of motion)4
Before icing every injury, let us remember when and why we need ice. Ice is beneficial to reduce inflammation and pain. However, ice can delay the healing process if not used correctly. Ice can be your friend and is deemed important during the healing process but at the right time. A general rule of thumb is to begin icing approximately one hour after the initial injury so that the natural inflammatory process has a chance to work. It is recommended to ice for 10-15 minutes at a time with about 90 minutes between ice sessions. This allows body tissues to return to a normal temperature so blood flow can return to the injured area. Ice packs should not be left on an injury overnight. When in doubt, please contact your school’s Athletic Trainer or your local Healthcare Provider.
Gary Salinas, LAT, ATC
Athletic Trainer, Douglas County High School
- Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57-65.
- Nemet, D., Meckel, Y., Bar-Sela, S. et al. Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial. Eur J Appl Physiol 107, 411 (2009). https://doi.org/10.1007/s00421-009-1138-y
- Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury? Journal of Athletic Training. 2004;39(3):278-279.