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Hi, 

I'm Maximilian, my goal is to help keep the BJJ community injury free.

Should You Ice it?

Should You Ice it?

Cryotherapy is a more fancy way of saying, “Put some ice on that”. Many of us have been told that by putting ice on to a recently injured segment, that we could reduce inflammation, swelling and pain.

When looking at the research on cryotherapy, it appears pretty controversial regarding the effectiveness for reducing swelling because the studies have been done are low quality and show minimal negligible benefit. The main benefit appears to be reducing pain by decreasing the conductivity from the nerves of the surface tissues.  In a small study, pain threshold and pain tolerance were improved in what the researchers thought was due to a decreased nerve conductivity and decreased activation threshold of the nerve endings. Cryotherapy has also been shown in rabbits to reduce muscle spasm. 

What is the best way to apply cryotherapy?

In order to reduce the nerve conduction velocity and subsequently reduce pain, the goal is to achieve a tissue temperature of 10 degrees. Crushed ice will achieve the goal skin temperature in 5 minutes however some types of ice gel packs and frozen peas do not get the skin temperature to lower than 13 degrees which would therefore have an inferior effect on pain. For the best result, wetted ice has been shown to be more effective than both cubed and crushed ice for cooling both the skin surface temperature and intramuscular temperatures. 

Many of us have probably been told to apply ice for 10 minutes on/ 10 minutes off for the next 2 hours following an injury, fortunately this method has been shown to be a superior to other methods of icing in regards to pain management. It must be said however, that different body types will require different durations. A lean athlete with injured tissue close to the surface will require a much shorter duration of icing as opposed to a meatier athlete with a deeper injury. For some injuries, it may be simply too deep to receive benefits from cryotherapy.

What about using padding or towels when applying cryotherapy?

Unfortunately using ice over the bandages or dry towels is reported to be ineffective. Although uncomfortable, wetted ice applied directly to the skin (possibly through a plastic bag) is significantly more effective. Although injuries are uncommon from using cryotherapy, there have been reports of injuries sustained from 60+  minute usage so it’s important to be sensible about it and check the skin every now and again.

What about Vaporcoolant sprays?

Vaporcoolant sprains contain menthol that produces the sensation of cooling and pain relief by stimulating cold-sensitive sensory neurons without actually cooling the skin. Although it might be helpful for pain reduction, it is not effective for cooling the skin and underlying tissues. 


References:

Algafly, A. A., & George, K. P. (2007). The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med41(6), 365-9; discussion 369. doi:10.1136/bjsm.2006.031237

Bleakley, C. (2004). The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials. American Journal of Sports Medicine32(1), 251-261. doi:10.1177/0363546503260757

Bleakley, C. M., McDonough, S. M., MacAuley, D. C., & Bjordal, J. (2006). Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med40(8), 700-5; discussion 705. doi:10.1136/bjsm.2006.025932

Bleakley, C. M., O’Connor, S. R., Tully, M. A., Rocke, L. G., Macauley, D. C., Bradbury, I., . . . McDonough, S. M. (2010). Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ340, c1964. doi:10.1136/bmj.c1964

Ewell, M., Griffin, C., & Hull, J. (2014). The use of focal knee joint cryotherapy to improve functional outcomes after total knee arthroplasty: review article. PM R6(8), 729-738. doi:10.1016/j.pmrj.2014.02.004

Kerkhoffs, G. M., van den Bekerom, M., Elders, L. A., van Beek, P. A., Hullegie, W. A., Bloemers, G. M., . . . de Bie, R. A. (2012). Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med46(12), 854-860. doi:10.1136/bjsports-2011-090490

Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med127(1), 57-65. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=25526231

Mitchell, A. C., & Thain, P. (2011). The Effect of Intermittent Ice Application on Dynamic Postural Control. The Journal of Strength & Conditioning Research25, S62-S63. Retrieved from http://journals.lww.com/nsca-jscr/Abstract/2011/03001/The_Effect_of_Intermittent_Ice_Application_on.98.aspx

Prado, M. P., Mendes, A. A., Amodio, D. T., Camanho, G. L., Smyth, N. A., & Fernandes, T. D. (2014). A comparative, prospective, and randomized study of two conservative treatment protocols for first-episode lateral ankle ligament injuries. Foot Ankle Int35(3), 201-206. doi:10.1177/1071100713519776

Williams, E. E., Miller III, S. J., Sebastianelli, W. J., & Vairo, G. L. (2013). ORIGINAL RESEARCH. COMPARATIVE IMMEDIATE FUNCTIONAL OUTCOMES AMONG CRYOTHERAPEUTIC INTERVENTIONS AT THE ANKLE. International journal of sports physical therapy8(6), 828-837. 

Algafly, A. A., & George, K. P. (2007). The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med41(6), 365-9; discussion 369. doi:10.1136/bjsm.2006.031237

Clinical Edge (2016), ‘Crushing the myths of ice application. Is ice useful for acute injuries and does it reduce swelling?’.

Dykstra JH, Hill HM, Miller MG, Cheatham CC, Michael TJ, Baker RJ. Comparisons of cubed ice, crushed ice, and wetted ice on intramuscular and surface temperature changes. J Athl Train 2009;44:136–41.

Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine. 2015 Jan 2;127(1):57-65.

Bleakley CM, McDonough SM, Macauley DC, Bjordal J. Cryo- therapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med 2006;40:700–5.

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