How Does Ice Contribute to My Recovery and Should I Use It?

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After having suffered an injury or getting surgery for that injury, your doctor or physical therapist may encourage you to apply ice to the affected area. This practice isn’t limited to major injuries and surgeries either; we’ve all been in a situation where we’ve bumped our head or some other body part really hard to the point where a bruise starts forming. When this happens, whether you’re a kid in school or an adult at work, people will encourage you to put ice or even a bag of frozen peas on it. They never seem to explain why you should put ice on it, but we still do it and oftentimes we feel better after doing it. Why does ice seem to help an injury or a surgical area of your body? What does ice do to contribute to healing or soothing the pain of our injuries?


Many healthcare professionals believe ice to be a valuable tool that can help patients with pain management and recovery.[1-7] At Curovate, we also believe in the effectiveness of this practice, especially for hip replacement and knee replacements as well as ACL tears and ACL surgery. In this blog we will discuss the specific benefits of ice that may help you recover from a total hip replacement or knee replacement, or an ACL injury or surgery.


Pain Management


You probably already know that ice is a great numbing agent; like when you start to lose feeling in your fingers and toes when you’re out in the freezing cold. The biggest case for the use of ice for your recovery is that it will greatly reduce any pain you will feel after a surgery.[1-5] Studies have found that people who use ice to treat pain after surgery had a significantly reduced need for pharmaceutical painkillers.[8] This is great news, especially considering the opioid epidemic we are facing right now. There is a consensus in the medical and research communities that we must limit the use of opioids and other pharmaceutical drugs to treat people for pain and that ice is an effective substitute.[8] Typically when you go home after a major surgery, using ice will be listed as one of your daily requirements. Following this advice will greatly help you manage your postsurgical pain.

There are a few reasons that might explain why applying ice is such an effective painkiller; according to one study, a reason could be that the cooling effect of ice increases your pain threshold and tolerance.[6] Another factor could be “sensory nerve inactivation”; basically slowing or stopping the pain signal from traveling to your brain.[6-7] Ice can also contribute by stimulating your brain to release endorphins which are essentially ‘happy hormones’ that will counteract the pain you would normally feel.[6-7] Ice contributes to reducing pain in many ways and, while some contributions aren’t fully understood, we can still safely recommend applying ice to an injured or surgical body part.

Reduced Swelling and Inflammation


Another benefit of ice is that you can use it combined with compression, to reduce swelling in the injured area. The Mayo Clinic defines swelling, also called edema, as “excess fluid trapped in your body's tissues.”[9] This happens usually in response to some injury as well as after surgery; it’s a normal part of the healing process. However, when you get injured, swelling is often accompanied by inflammation which includes sensitivity, redness, and heat[10] which can be very painful. Using ice will numb the pain while compressing the area will reduce the excess fluid that is causing the swelling and inflammation. Just another benefit of icing the affected area after a total hip or knee replacement, or an ACL tear!


Does Ice CURE the Area of my Injury or Surgery?

Here is a very common conversation I have with my patients after knee injury or surgery.

Patient: Does ice actually cure my surgical knee?

Therapist: No

Patient: Then why should I use it? Am I not wasting my 20 minutes using ice if it doesn't do anything?

Me: It is accurate to say it does not cure your knee. Meaning it is not going to put ligaments back together, it is not going to heal muscles or restore normal range of motion in your knee. Your body's healing capabilities will do this over time. However, it is not accurate to say that ice does nothing. Ice can absolutely help reduce your sensation of pain. Ice can reduce the need for pain medication. Ice can also help with reducing your swelling around your knee if you use it with compression. This will allow you to do all of the critical exercises that you need to do daily to recovery from this knee surgery.

Patient: Okay I guess that makes sense.

Ice does not cure an injruy, but it is still very useful after injury or surgery.

Conclusion


Essentially, ice is a non-invasive, accessible, and non-addictive alternative to painkillers and other medications used to alleviate pain and swelling in people who have have had a total knee repalcement, total hip replacement, ACL tears, and a lot of other joint and ligament injuries and surgeries.[1-8] The amount of time that you should ice your injury will depend on what your healthcare professional recommends, usually 10-20 minutes per session. Ice can be recommended between once to several times per day. In the early days after knee surgery you may be asked to ice your knee 5-7 times in one day! Much of the evidence for the amount of time you should ice is highly variable and there need to be more research studies to confirm the most appropriate time to ice based on the injury or surgery.[11] Remember, icing is generally safe but it’s always safest to consult your healthcare professional for advice before icing your recently-operated or injured area. And remember if you have had surgery and are using ice, keep your knee or hip clean and dry while applying ice for pain relief.

You can find more information about recovery from Hip and Knee replacements as well as ACL tears and surgery from our Curovate App! Curovate is an app for physical therapy. Within the Curovate app, there are personalized rehabilitation plans which include video-guided exercises and precise scheduling of when to perform these exercises at your stage of recovery. Proper rehabilitation, which is accomplished with diligent exercise and pain management, is key to ensuring your body can recover at (near) 100% of its ability before sustaining the injury. Click the links below to download the Curovate physical therapy app, available for iOS and Android devices!

If you need further customized assistance during your recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

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References

1. Pan, L., Hou, D., Liang, W., Fei, J., & Hong, Z. (2015). Comparison the effects of pressurized salt ice packs with water ice packs on patients following total knee arthroplasty. International journal of clinical and experimental medicine, 8(10), 18179–18184.

2. Adie S, Kwan A, Naylor JM, Harris IA, Mittal R. Cryotherapy following total knee replacement. Cochrane Database Syst Rev. 2012;9

3. Macedo LB, Josue AM, Maia PH, Camara AE, Brasileiro JS. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. Physiotherapy. 2015;101:155–160.

4. Block J. Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: A narrative review. Open Access J Sports Med. 2010;1:105–113.

5. Fang L, Hung CH, Wu SL, Fang SH, Stocker J. The effects of cryotherapy in relieving postarthroscopy pain. J Clin Nurs. 2012;21:636–643.

6. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold, and pain tolerance. Br J Sports Med 2007;41(6):365-369; discussion 369.

7. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther 2010;90(4):581-591.

8. Clarke, H. A., Manoo, V., Pearsall, E. A., Goel, A., Feinberg, A., Weinrib, A., Chiu, J. C., Shah, B., Ladak, S. S., Ward, S., Srikandarajah, S., Brar, S. S., & McLeod, R. S. (2020). Consensus statement for the prescription of pain medication at discharge after elective adult surgery. Canadian Journal of Pain, 4(1), 67–85.

9. Mayo Foundation for Medical Education and Research. (2020, December 1). Edema. Mayo Clinic. Retrieved October 11, 2021, from https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/syc-20366493.

10. GW;, S.-S. (2006, April 7). Analysis of inflammation. Annual review of biomedical engineering. Retrieved November 1, 2021

11. Weber, K. (n.d.). The technical benefits of icing - inverse med. The Technical Benefits of Icing. Retrieved November 1, 2021