What No Active Person Should Be Without: Ice

If you want to find out how athletic a family is, check their closets for sports shoes and equipment. Or you can open their freezer and count how many kinds of ice packs they keep handy.

Injuries happen, as any active person will tell you. And for virtually any sports boo-boo, from a black eye to a sprained ankle, ice is nearly miraculous in its ability to ease pain and promote healing.

In our freezer, for example, if you want to find food you’ve got to move several different sizes and shapes of “chiropractic ice aids”--therapeutic gel packs that remain flexible when frozen to conform to the curve of a back or leg. I also stock several bags of frozen corn or peas because they fit nicely around scraped knees and elbows. Plus we keep plenty of juice Popsicles on hand since kids are much more likely to keep ice on a split lip if the ice is flavored.

Even though ice can work wonders to heal sports injuries, many people still are confused about which to apply when they get hurt, ice or heat. The general rule is this: Ice for the first 48 to 72 hours, heat after. And when in doubt, apply ice. It’s the most effective, safest and cheapest form of treatment.

“Cooling the injury--in medical terms, cryotherapy--decreases swelling, bleeding, pain and inflammation,” writes sports medicine specialist Lyle Micheli in “The Sports Medicine Bible” (HarperPerennial, 1995). “For maximum effect, ice needs to be applied within 10 to 15 minutes of the injury’s occurrence.” So even if you’re on your way to the doctor, icing the injury immediately will help speed recovery. This is a good reason to keep an “instant ice pack” (which turns cold when you crush the inner liner) in your gym bag, first-aid kit or glove compartment. These chemically activated ice packs cost about $1.50 and are available in sports shops and medical supply stores.

There are several popular methods of icing. My favorite is to cover the injured area with a thin, wet tea towel, since a dry towel or one that’s too thick will insulate the skin from the cooling effect. Then place a plastic bag full of ice or a frozen gel pack over the injured area. Depending on the injury, I may also wrap an elastic bandage over the ice bag, which keeps it in place while simultaneously applying compression, another effective healing technique.

At first, the ice produces a sensation of aching or burning. But within five to 10 minutes, the anesthetic effect takes over and the area feels numb. It’s important not to leave ice on for too long, since excess exposure could damage skin and nerves. That’s why sports medicine experts advise icing the injury for 10 to 30 minutes, then taking a break of 30 to 45 minutes before the next 10- to 30-minute icing session.

The duration of each icing session depends on the person’s body type and the kind of injury. “In thin athletes, significant muscle cooling occurs within 10 minutes, whereas fatter athletes may take 30 minutes to achieve comparable results,” Micheli notes. And an ankle or knee might require less icing time than a thigh or bicep because the joint ligaments lie closer to the skin’s surface than the deeper muscles.

Another popular icing technique is the ice massage. This is done by freezing water in a paper or polystyrene cup. Tearing off the upper edge of the cup leaves the base as an insulated grip so you can hold the “ice cone” and massage the hurt area with slow, circular strokes.

In the past, icing was recommended for 24 to 48 hours after an injury, but evidence now suggests that intermittent icing may be beneficial for up to seven days, particularly for severe bruises, Micheli says. “The first 72 hours are especially critical, and icing should be done as much as practically possible during this period,” he notes.

Switch to heat only after any swelling and redness are gone. Hot towels, whirlpool baths and hydrocollators (moist heating pads) are popular ways to apply heat. If you have an old, chronic injury, you might want to apply heat before you work out, then ice the area after exercise.

One caution: Ice therapy “should not be used by anyone with rheumatoid arthritis, cold allergy, peripheral vascular disease or conditions such as Raynaud’s phenomenon, vascular problems or decreased sensation,” writes Louisiana physician Kim Edward LeBlanc in the American Running and Fitness Assn.’s newsletter, FitNews.

But for most active people, ice is nice, particularly in the swelter of summer.

* Fitness runs Monday in Health.