If you’ve got an ache, try an ice pack, suggests sports medicine expert

It’s common knowledge that minor aches and pains can be treated by applying cold or heat, but knowing how and when to use these treatments can be tricky, according to Rick W. Wright, M.D., assistant professor of orthopaedic surgery and sports medicine physician at Washington University School of Medicine in St. Louis. Wright, who serves as a team physician for the several St. Louis area professional sports teams, offers some advice on proper use of hot and cold therapies in an article published recently in the St. Louis Post-Dispatch.

(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Health and Fitness section on Monday, August 25, 2003)

Cold comfort: If you’ve got an ache, try an ice pack

By Virginia Gilbert

Mothers knew this long before scientists could explain it: Ice makes an ouchie feel better, and a cube judiciously applied in the mouth at first scream cuts down on the crying.

Rick Wright
Rick Wright

Researchers are still studying the best method of applying cold and heat therapy to relieve pain and reduce swelling, or relax and stretch muscles.

But physical therapists and doctors who treat athletes agree: Heat is good for stretching. It increases blood flow to the area where it’s applied and it can relax the muscles.

And when you hurt yourself, chill. Immediately.

“Ice is great at decreasing inflammation and swelling and controlling pain,” says Dr. Rick Wright, one of the doctors in Washington University’s orthopedic surgery group that serves as team physicians for the Rams, the Blues and the Cardinals. “Most of the time, heat should not be used for injuries,” Wright says. “It will increase swelling.”

It’s the same principle for sprains, strains, contusions and sore muscles, as well as surgical pain. Wright says he encourages post-surgical patients “to continue to ice beyond the point they think they need to.”

How long is that? A very mild ankle injury could be better in a week, he says, while a ligament reconstruction may take months before it is back to normal. Keep icing, he says.

Ryan Lampe, a physical therapist with the Missouri Bone and Joint Center in Creve Coeur, has experience as patient and therapist. Lampe, 31, played on the Quincy College varsity baseball team and now is a catcher in a league of former college players. He’s had four knee surgeries.

Lampe and his teammates often apply hot packs or get heat rubdowns before a game. And he ices his knee after every game, even if he doesn’t feel any swelling.

“It’s all based on degree of the injury and the person’s pain tolerance,” Lampe says.

Researchers have tried to quantify the body’s reaction to cold and heat, measuring various responses, including the degree of swelling of an injury over time with and without cold or pressure. Studies have shown that cold is useful for muscles and joints as well as just near the skin, where you can feel the cold.

A study reported by the University of Kansas Medical Center last year suggests why this is so. Researchers led by C.S. Enwemeka found that cold therapy penetrates in layers beneath the skin only after the cold pack is removed.

The authors, writing in the journal Medicine and Science in Sports and Exercise, suggested that heat was being transferred from the deep tissue to warm the upper layers of skin and that this interchange thus cools the deeper layers.

That means you don’t have to wait until numbness sets in to benefit from cold therapy. Most medical advice cautions not to use cold for longer than 20 or 30 minutes at a time, and not to use very low temperatures that might cause frostbite or nerve injuries.

These days, drugstores are full of cold and hot packs, gel wraps, chemical instant cold therapy and microwaveable heating pads. They’re more convenient and less messy than melting ice or heating pads with cords and plugs. Often they can be wrapped around an arm or knee, or across a shoulder, to give compression as well as temperature therapy.

Many cold packs don’t get cold enough to do serious damage if left on too long. But that can be a problem, too, because if they’re not cold enough or don’t cover a large enough area, they may not be effective.

Professional sports teams, which have the best of everything available use . . . Ziploc bags with ice cubes, according to Wright. “It’s not very complex,” he says. “Cold is cold. A bag of frozen vegetables out of the freezer works as well as anything.”

Leave it to a scientist to test that. Last year a group of researchers at Coventry University in England published a study concluding that a 454-gram packet of frozen peas can cool an extremity to clinically significant levels – that is, enough to reduce pain and swelling – better than flexible frozen gel packs.