Use of Ice and Heat (Care of the Young Athlete)

When not to use ice

• Immediately before physical
  activity

• If area of icing is numb

• When the pain or swelling involves a
  nerve (such as the ulnar nerve or “funny bone”)

• If the athlete has sympathetic
  dysfunction (an abnormality of nerves that control blood flow and
  sweat gland activity)

• If the athlete has vascular disease
  (such as poor circulation due to blood loss, blood vessel injury,
  compartment syndrome, vasculitis, blood clots, or Raynaud
  disease)

• If there is skin compromise (such as
  an open wound; a wound that has not healed; skin that is stretched,
  blistered, burned, or thin)

• If the athlete has cold
  hypersensitivity, including cold-induced urticaria (hives from
  cold)

How long to use ice

• Two to 3 times per day (minimum); up
  to once per hour.

• Duration varies with technique;
  usually 20 to 30 minutes per session. (See “Options for
  applying ice.”)

• Ice may continue to be useful in
  treatment as long as there is pain, swelling, inflammation, or
  spasm. There is no need to switch to heat after 48 hours or
  alternate between ice and heat.

Options for applying ice

1. Ice packs are best for icing
larger areas of pain, swelling, or spasm (like a swollen knee, deep thigh
bruise, muscle strain, shoulder tendonitis, or neck or back spasm).

• Materials

  • Small cubes or crushed
    ice in plastic bag.

  • Bag of frozen vegetables
    (such as frozen peas).

  • Reusable commercial ice
    pack or circulating “cryocuff” (made
    specifically for therapeutic icing). Do not use blue ice
    packs directly on the skin; they are colder than frozen
    water and can cause frostbite.

• Method

• Place on the affected area for at
  least 20 minutes per session. Hold in place with a towel, elastic
  wrap, or shrink-wrap.

2. Ice bath/ice whirlpool is
used to reduce swelling in peripheral joints (such as with ankle sprain,
wrist sprain, or severe shin splints).

• Materials

  • Bucket or tub with mixture
    of ice and water

• Method

  Immerse affected area for 20 to 30
  minutes per session. Do not use an ice bath if there is an open
  wound, bleeding, or a skin infection.

3. Ice massage is used to
reduce superficial, well-localized inflammation (for example, tendonitis of
the hand, wrist, or elbow; heel or elbow bursitis; ganglion cyst;
apophysitis; or irritation of a growth plate).

• Materials

  • Ice cube or frozen ice cup
    (made by freezing water in a paper or Styrofoam cup)

• Method

  Rub ice in a circular pattern over
  the affected region for 8 to 10 minutes per session.

When not to use heat

• After physical activity

• If the area is numb

• If there is an open wound or
  burn

• Immediately after an acute
  injury

• If body temperature is elevated from
  fever or heat stress