Issue 021
January 2007
By Graham S Smith
Ice has been used for centuries as a treatment for soft tissue injuries. It was mentioned by Hippocrates almost 2 ½ thousand years ago. But does it work, and if so, how and when should it be applied?
As with most things medical, the research is not entirely clear. There seems to be little doubt that applying ice will cause changes in physiology. When ice is placed on the skin the tissues underneath begin to cool. This causes blood vessels to contract, therefore reducing the flow of fluid into the area. After a certain period of time, somewhere around 20 mins, the lymphatic system becomes more permeable.
This can cause more fluid to flow out of these vessels and into the tissue being cooled. Other noted changes are a decrease in nerve receptor activity, a decrease in tissue metabolism and other more systemic effects such as changes to blood pressure. So what does this mean to the injured fighter?
1. Cooling of tissue is desirable, as it will help to minimise swelling by contraction of the vessels. However, this should not be done for a sustained period of time or there is a potential for the swelling to increase through a change in the lymphatic system
2. Research has shown that tissues continue to decrease in temperature for several minutes after the coolant has been removed, therefore cool for 10 mins at a time to be on the safe side.
3. The decrease in nerve activity is important as it reduces pain information getting to the brain and registering resulting in less discomfort. Many research projects have shown injured subjects will need to take significantly less painkillers if they are using ice as part of their rehabilitation. The drawback is that all nerves in the cooled area are affected meaning that icing should not be done before training as this could interfere with the nerves responsible for balance and movement coordination and potentially lead to more injuries.
4. Decreased tissue metabolism will help by reducing swelling and leave more nutrients from the blood to be available for the injured tissue.
5. It is important to appreciate that cooling tissues can alter other body functions, such as blood pressure, especially if this form of treatment is abused.
6. There is a real danger from tissue damage (necrosis) if icing is done for too long or without correct precautions. Ice should never be applied to an area that has a decreased nerve supply or decreased blood supply, there should always a thick damp towel between the ice and skin, the fighter should always be aware of the dangers and precautions before using this form of treatment (fighters with potential concussion should not be left to follow these instructions on their own)
7. Ice should never be applied to the Carotid artery area (front of the neck) as this can have an adverse effect on blood pressure
To summarise the treatment:
Apply ice as soon as possible after injury. Leave on for 10 minutes remove for 30 minutes and reapply for 10 minutes. Continue with this process for up to 48 hours and reduce to 10 minutes every 2 hours if needed, for up to a week after the injury. If the problem is not significantly better within 48 hours medical attention should be sought.
Graham S Smith is a chartered physiotherapist based in Newcastle and has worked with both professional and recreational MMA athletes. He can be contacted by email at [email protected].
