To Cold Pack or Not to Cold Pack


This subject has come up for discussion recently due to the American MD that created the concept in the 1970's rescinding his opinion. MD Gabe Mirkin stated in March 2014 as follows:

 

"Coaches have used my "RICE" guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping"

 

I have had some clients question the use of ice after treatment, so here is my opinion:

 

The premise of the discussion is that the body's blood has an innate ability to bring anti-inflammatory properties to a site of injury and heal it. If you restrict that blood flow in any way you are reducing this healing capacity. This definitely makes sense.

 

In clinic the way we use 'cold packing' aims to assist this process. Here's the ways in which we use ice protocols:

 

Post Treatment Cold Packing

 

After you've had a treatment quite often you are told to put cold onto the site of the discomfort for 5-10 minutes each hour until you go to sleep. The aim of this is the reduce heat, as ice is an analgaesic is reduces discomfort. When the cold is then removed, blood will flood the area and bring those healing anti-inflammatory properties in.

 

In my clinic experience I have had customer who, with the same injury, have cold packed post treatment and then forgotten to cold pack post treatment and have experienced prolonged discomfort from not doing so.

 

As our aim is primarily to reduce discomfort then I am happy to continue with this method.

 

In particular I have found with rotator cuff injuries, that putting a cold pack on the shoulder for 5-10 minutes directly before sleeping help to get that client further into their sleep hours before waking up with that familiar nagging ache. As sleep is so important for healing, thats really important to me.

 

Hot/Cold Protocol

 

Sometimes (and particularly in an older population) I will suggest 10 minutes of hot then 10 minutes of cold. This will bring heat to muscles which feels comfortable and then the cold will reduce the heat, again reduce discomfort, then once removed blood will again flood into the area.

 

Combination of Hot/Cold

 

Sometimes (in an extremity or an area with very reduced blood flow) I will suggest 90 seconds each of cold/hot/cold/hot/cold. As with the above I am creating a pumping action of blood flow in and out of the tissues. The cold slows blood flow, but then when you remove it and bring in the heat, by-products of inflammation are removed and then anti-inflammatory products flow in.

 

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With all of these protocols our aim is to be able to create a window, where the client can exercise, yes, this is the main priority post treatment, to be able to move the joint/muscle in a normal (functional) manor.

 

We may suggest rest from a sport that aggravates any injury but there will always be an exercise that can be undertaken to improve tendon/joint function at that site of injury.