Rice and ice therapy can help recovery and reduce pain

When treating exercise-related injuries, applying ice to the injured body part is an important aspect of first aid (Rest-Ice-Compression-Elevation (RICE)) and of physical rehabilitation therapy in later stages of healing. Cold therapy (ice) helps reduce bleeding, inflammation, swelling and pain.

Knowing how to apply cold therapy is important to avoid exacerbation of injury. Ice therapy should begin immediately after injury. Apply ice packs for 20 minutes directly on the skin. Four times per day is sufficient, but one can safely apply ice every hour for better anti-inflammatory effect.

The goal of ice therapy is a skin temperature of 10 to 15ºCelsius. Within this range of temperature, there is reduction in cell metabolism without cell damage. A standard ice pack (1 kg ice in a plastic bag) cools the skin to 14ºC after 30 minutes.

Factors that affect the magnitude of reduction of skin temperature include the nature of the barrier between ice and skin (no barrier or a damp washcloth are best; padded bandages are no good), the thickness of skin fat, the method and duration of application, and the depth of the injured tissue from the skin surface. The greatest fall in skin temperature occurs within the first 10 minutes of cold therapy. Ice massage cools muscles more rapidly than application of ice packs. The combination of ice and compression (an integral component of RICE) is more effective in reducing temperature and controlling swelling than either ice or compression alone.

Cold therapy methods include ice packs, ice massage, ice baths, and vapocoolant sprays. Melting iced water is best for use in ice packs. Ice straight from the freezer and reusable gel cold packs may have temperatures much lower than zero degrees Celsius and can cause cold injury and frostbite if applied directly to skin. Ice massage consists of rubbing the injured area with an ice cube for approximately 10 minutes per session and is safe and inexpensive.

Ice baths are ideal for cooling large areas or limbs. Vapocoolant (e.g., ethyl chloride) sprays are useful for rapid cooling of a bruise.

Avoid ice therapy in those with impaired limb circulation (e.g., some diabetics), Raynaud phenomenon, impaired sensation, cold allergy/hypersensitivity, severe cold-induced urticaria, cryoglobulinemia, and paroxysmal cold hemoglobinuria. Athletes should know that cold therapy might temporarily affect muscle performance and position sense.