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