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What is your first reaction when dealing with small injuries?

edited July 2015 in Discussions
Hi all!

I thought icing an injury was the fastest and best way to prevent it to get worst. But I just read this article and they say the exact opposite.

In your opinion what's the best way to react?
Post edited by Tom Morgan on


  • I think ice has it's place, just as he noted in his article. I would also go further, and say that during competitions or events, where you want to help the athlete control the pain. Ideally, we want our patients and athletes to only participate fully when pain free. Realistically, we know that this isn't going to happen. How many players in the super bowl or the NHL Stanley cup finals do you think participate pain free?
  • As Bryon said ice has its place and time but I think the problem is that people live and die by icing. When people use it as a means of prevention instead of using exercises, a combination of ice and massage, active recovery, or Aquatic therapy that cryotherapy loses its efficacy and the evidence based approach isn't being utilized appropriately. Education plays a big role too because more often than not you have athletes come into the Training Room and either asking for ice or grabbing a bag of ice themselves and doing nothing else to treat their symptoms. But to answer the initial question of how you handle a situation is based on the subjective and objective information that is gathered by the evaluation performed and based upon your findings the appropriate treatment can be administered.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • I teach pathophysiology and spend a lot of time discussing the healing process/phases. First, the inflammatory response is almost always greater than what it needs to be (due to secondary injury to healthy cells caused by temporary hypoxia), and second, ice will absolutely not stop inflammation from occurring. The problem with the outcomes data is that many times ice is used in situations where the inflammatory response is minimal or non-existent to begin with. Overuse injuries for example (plantar fasciitis, tendonitis, etc.) do not have the same intense inflammatory response that occurs after an acute injury, hence, icing is not as critical for these types of injuries (although I do advocate icing after intense activity to prevent pain and spasm after exercise). Also, pain by itself does not necessarily indicate the presence of inflammation. I acknowledge the discrepancies/inconsistencies in the outcomes, but the conclusion made in this article is not accurate. Ice does not stop inflammation, it limits the amount of excess interstitial fluid accumulation which in turn facilitates rehab. Ice is absolutely not detrimental after an acute injury, it is necessary. ATCs just need to do a better job at discerning when it is necessary and when it isn't, and the outcomes would be more consistent.
  • Thank you all for your very interesting replies.
  • You can treat some injuries with cold but I believe it depends of the type of injuries you deal with. For some heat treatment can be more efficient.

    Heat therapy should be used in case of chronic/recurrent injuries, pain involving muscle, muscle strain, or stress because then lactic acid builds up in them causing pain.

    However, cold therapy is used when facing acute pain or a new injury that is swollen, inflamed, red or sensitive. It calms the pain but that doesn't mean the injury suddenly disappeared therefore it is important to check and treat the injury if necessary.
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