I was recently asked: “Can you clarify something for me? When is it appropriate to use ice on an injury as opposed to heat? I say ice for everything, but my running partner swears by heat for muscle-related injuries. Which one of us is right?”
When it comes to running injuries, the woman who asked the question is right – 95% of the time. Why is icing (known by health professionals as cryotherapy or cold therapy) so effective in treating running injuries? According to physical therapist Nikki Kimball, who was named USATF’s (USA Track and Field’s) Ultrarunner of the Year in 2004, 2005 and 2007: “Cryotherapy constricts blood vessels and decreases metabolic activity, which reduces swelling and tissue breakdown. Once the skin is no longer in contact with the cold source, the underlying tissues warm up, causing a return of faster blood flow, which helps return the byproducts of cellular breakdown to the lymph system for efficient recycling by the body.”
In plain English, ice is nature’s anti-inflammatory, without negative side effects.
Any new injury or the re-aggravating of a chronic injury (e.g. shin splints, plantar fasciitis) should be aggressively treated with ice. Ice for 15-20 minutes, immediately after you stop running. Repeat as often as possible, allowing the treated area to return to regular skin temperature between ice treatments (an hour, to be on the safe side). With a new injury, implement this regimen for the first 48 hours. In the case of a chronic injury, ice throughout the day if you felt pain during running or if you experience post-run pain.
What is best way to ice? Homemade ice packs work just as well as commercially available ones. However, the often-recommended bag of frozen vegetables loses its effectiveness too quickly. Also, other family members may not want to eat the vegetables afterwards. More than one runner’s child has exclaimed: “Uugghh, they practically touched your sweat. I’m not eating them.” Convincing most kids to eat their veggies is tough enough.
To make my two favourite homemade icing devices that I keep handy in the freezer:
1. Take a styrofoam cup, fill it with cold water and freeze it. When you require ice, peel back the top half of the cup, leaving the bottom half to insulate your fingers when you use it treat the injured area. Gently move the ice cup in either a back and forth or circular motion over the injury site, thereby giving you an effective ice massage. This method is especially effective when the treatment area is smaller than the diameter of the cup. Keep several frozen cups on hand because each one will be good for only two or three applications.
2. To treat larger surface areas, take a large heavy duty Ziploc (or similar) freezer bag. Fill it with four parts ice cubes or crushed ice to one part rubbing alcohol. The rubbing alcohol will lower the freezing point of the ice so that the contents of your ice pack will not freeze into a solid iceberg and can be reused multiple times.
Two words of caution:
1. In order to prevent frostbite, do not allow the ice to sit on your skin without a layer of protection. Either move it continuously (see #1 above) or place a thin towel between the ice and your skin.
2. The following is applicable if you are dating a non-runner. He/she may check out your freezer in the mistaken belief that you can tell a lot about a person by the contents of their fridge and freezer. My wife-to-be had second thoughts about our relationship when she opened my freezer for the first time. Good thing I had some chicken, fish and frozen veggies there too.
The only type of running injury for which I’d recommend the application of heat is for chronic injuries, if you find it helpful to loosen or relax the area prior to running. A hot shower or damp washcloth are effective. Do not use heat after running.
Using ice or heat does not address the underlying cause of injury. With the exception of injuries that result from a sudden trauma, e.g. a sprained ankle, most running injuries are caused by biomechanical weaknesses, poor running-specific strength and/or flexibility and training errors. Ice/heat can be a critical component of your injury management regimen that keeps you on the roads or enables you to quickly resume running while you tackle the root cause of the injury.
