The disclaimers
You should probably avoid ice or do so only with the guidance of a healthcare professional if you have poor circulation to the area concerned, or a loss of sensation / nerve damage. As usual, if you’re not one of my patients and aren’t sure if an ice pack is the right kind of treatment for you, then do consult with your healthcare professional.
Making an ice pack
Okay, so the unthinkable has happened and you’ve injured yourself – whether it’s a sport injury or you’ve tripped over the cat, it doesn’t really matter. What do you do? You put ice on the injury, right? We’ll talk about the overall management of an acute injury in a future post, today is purely about how to make an ice pack. It’s at this point that a lot of patients visiting the clinic tell me they reach for a bag of frozen peas, but here is why that might not be the best idea. Firstly, it’s your food defrosting on your body, and quite possibly a sweaty part of your body as well, if you’ve just been exercising, so I don’t really fancy coming round to yours for dinner anytime soon thanks-very-much! An NHS website says that you shouldn’t eat frozen peas after doing this – thus advocating keeping food in your freezer that is not edible!
More importantly, a bag straight from the freezer will have ice crystals on it, and if they get trapped between the bag of peas and your skin, they can cause an ice burn, and I have heard stories of these over the years. So, then people say they wrap the peas in a towel, but this creates quite a thick insulating layer between the peas and them, which diminishes the effect of the ‘ice’ pack.
Thankfully, there are some recommendations, which originally came from the Chartered Society of Physiotherapy and were called the PRICE guidelines, but they aren’t in print anymore, but I’ve collected them here.
Top Tips
1. The most effective form of ice pack is by using ‘proper ice’, not gel packs you put in the fridge and certainly not those chemical packs you need to shake. So you can simply take a sandwich or freezer type bag – a plastic bag that hasn’t got holes in it and hasn’t been in the freezer – and fill it with ice cubes. You don’t need to crush them, and as long as the ice cubes aren’t huge, it won’t be a problem.
2. Add a small glass of water to the bag of ice. This will kick start the melting process and for this the ice needs to take energy from the surrounding area and therefore has a stronger cooling effect on your skin.
That’s your ice pack sorted!
But there’s more. Sorry!
3. When people say to wrap the frozen peas in a towel to insulate the skin a little bit, the principle is correct even if, as I said at the start, it’s a bit counter-productive. The best thing to do is to take some kitchen roll, run a sheet or two of it under cold water and squeeze it out. This is your insulating barrier – just like the towel was for the peas – but it’s very thin, and it’s already cold and wet from running under the tap, so will have more of an instant effect when you add the ice.
4. Finally – I know this seems like a bit of a faff if you’ve got a sore knee and just want to get some ice on it, but I promised you the most effective ice pack, and this is it! Okay, so, finally, get some oil – it can be anything, baby oil, olive oil, doesn’t matter – and smear some over the skin where you are going to be placing the wet paper towel and the ice pack. This gives you a very thin oil layer also protecting the skin.
So, we have a bag of ice cubes that’s already melting and therefore needing energy from warm skin to help that process, which should make it a very effective coolant. This ice has been insulated slightly from you because of the clean plastic bag you’ve used that hasn’t been in the freezer. We’ve then got a protective layer of wet paper towel that will help transmit the cold, and a further protective oil layer that will help stop an ice burn.
Now you’ve got everything ready, get yourself as comfortable and supported as you can, preferably with your injured ‘bit’ elevated, and put your ice pack in place. How long do you keep the ice pack on? Well, I’ve always said it should be 10-12 minutes, but reading current research for this post suggest up to 20 minutes. Despite all these precautions, I’d still be a bit nervous of that length of time, so I probably wouldn’t go longer than 15minutes.
There is also a bit of variation in the research about how often you should ice something – some say as often as every two hours, some say more like two to three times a day. I tend to favour the second option, just from a practical point of view, but you can ice more regularly if you are incapacitated or are post-op.
Your skin might be red, tingly or even numb post-icing, which is fine provided it returns to normal fairly quickly, and certainly before you apply the ice again, which might also mean you can’t ice it as often.
You really want to ice the injury for the first 48-72 hours post-injury then consider stopping as it may well not be doing much after this, AND, we need to consider that inflammation is part of the normal healing process, so you need some, you just don’t need excessive amounts.
In a future post, we’ll talk about overall management of a new injury and some of the current research. But in the meantime, if this was helpful, please give it a share around on your socials!
Please do get in touch if you’ve got a problem you’d like me to take a look at.
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