Rose Mary has been an occupational therapist since 1987. She has extensive experience treating conditions of the hands and arms.
Ice: An Underappreciated, Effective Treatment
Ice is an inexpensive yet astoundingly effective treatment for pain and swelling. Unfortunately, it is a grossly underutilized tool. A big reason for this is that many healthcare providers themselves do not appreciate the benefits of ice packs and other cold treatment modalities for pain or swelling. Some providers simply don't know about ice's benefits and therapeutic use.
I was one of those providers until my physical therapy colleagues enlightened me. Many providers, unfortunately, propagate misconceptions about the use of ice. If I had a dollar for every patient that told me, "The emergency room told me to ice for two days, then use heat," I'd go on a nice European vacation.
What Ice Does
Ice initially constricts local blood vessels and decreases tissue temperature. Overall, ice will:
- Decrease inflammation
- Decrease pain
- Speed nutrients to the area
- Promote healing
- Decrease swelling
- Decrease tissue damage
- Decrease muscle spasm
Four Stages of Icing
During treatment with ice, you will go through the following stages:
To be clear, icing is not recommended because it feels great when you're doing it, but because it is a proven tool in our arsenal against pain and inflammatory conditions! I found early on with clients that this is a point on which you have to beat the poor horse to death several times over. I would direct clients to ice 3 to 5 times a day in their treatment plan.
On follow-up, I would ask how many times a day they iced. Some would say, "I didn't ice. It didn't feel good. I used heat instead." I had to mentally excuse myself to beat my head against the wall. Heat tends to feed pain and inflammation, no matter how good you think it feels in the moment.
Indications: Some Uses for Ice
Ice and cold treatments constrict blood vessels, helping to decrease swelling. Even though you may think heat feels better, heat dilates or opens up the blood vessels, like turning on the full faucet blast. If you injured your ankle and it was swollen as big as your head, do you think the swelling is going to be resolved in 2 days? Given this new knowledge, do you really think it’s a good idea to switch to heat on day 3 for your still swollen ankle? Icing is beneficial for sprains, strains, and fractures.
Although I can’t imagine icing stiff and arthritic fingers, there is good evidence in the literature for icing arthritic hips, knees, ankles, shoulders, necks, and backs. It is a misconception to ice only known injuries within the first 48 hours. When interviewed about turning 50, Denzel Washington noted he was still very active physically. After vigorous physical activity, he noted he ices practically everything, almost like filling a tub with ice and getting in!
For chronic musculoskeletal pain, when in doubt, you can rarely go wrong with icing. On the whole, my clients with chronic shoulder pain from a variety of causes reported icing to be their single most reliable pain management tool. Inflammatory conditions such as tendonitis, “pinched nerves”, and nerve compression syndromes such as carpal tunnel benefit from icing.
In general, you want to be sure your pain is musculoskeletal. Sometimes jaw or upper extremity pain can be signs of a heart attack, even in the absence of any chest pain. Upper and lower extremity pain and other symptoms such as weakness or numbness can be due to a stroke. If your arm, leg, neck, or back pain is new, see your doctor to ensure that the pain is musculoskeletal.
Since icing is very effective for decreasing swelling, individuals with congestive heart failure should be closely supervised by their doctor. Reduction of swelling in the extremities may overload the heart.
Read More From Healthproadvice
Clients with Raynaud’s phenomenon are extremely sensitive to cold and are not good candidates for icing. Under physician supervision, they may benefit from alternating warm and cool packs.
Three Methods for Ice
Ice Massage: Freeze water in an 8 oz Styrofoam cup, then tear the edges exposing the ice, leaving some of the cups to hold onto. Using a continuous motion, rub the ice over the area of treatment for 5 to 10 minutes. I recommend 10 minutes for larger, deeper structures like shoulders or knees. Usually, 5 to 8 minutes is adequate for small or superficial structures, such as wrists or elbows. Repeat 4-5 times daily. Numbness is the desired effect and needs to be achieved to be effective.
Ice Bath: Ideal for hand and forearm or foot and ankle. Immerse the part in a bucket of water and then add ice. This is hardcore! Typical immersion time is 5 to 10 minutes. Although the maximum recommended time is 20 minutes, I’ve only come across the occasional athlete that has reported doing such. If your injury is to your wrist, with no swelling in your fingers, you can leave your fingers out of the ice bath. If your injury is to your ankle and swelling does not extend into your toes, you can leave your toes out. Repeat during the day, preferably 3-4 times. The body part should be continually moving during treatment to create a pumping action to help achieve a better reduction of swelling.
Ice Pack: Use a re-freezable ice pack or put crushed ice in a thin towel or plastic bag and place it over the area to be treated. Keep a T-shirt or towel between body parts and ice. Use 15-20 minutes. Repeat 4-5 times daily. Maximum ice time is 30 minutes with at least one hour between icings. Again the desired effect is numbness!
How Many Times to Ice and Other Useful Tidbits
Generally, icing in any combination of the above methods is recommended 3-5 times a day. You may ice more than 3-5 times a day. Follow guidelines for each method to avoid cold damage.
For nerve compression syndromes like carpal tunnel, cubital tunnel, and radial tunnel, an ice pack is recommended for 12 to 15 minutes. For tendonitis, such as tennis elbow or tendonitis of the wrist or thumb, I recommend ice cup direct ice massage at least 1-2 times a day, and ice pack 2-3 times a day to make up the difference, for a total of 3-5 times per day.
If you can do the ice massage 3 to 5 times a day, great! Although my specialty as an occupational therapist is upper extremity, I have had ice prescribed to me personally for my knees for arthritis as well as occasional patellar (kneecap) tendonitis. I sometimes use ice packs but tend to cut to the chase and do direct ice massage for my knees.
The nerves are very close to the skin’s surface at the cubital tunnel, or funny bone on the inside of the elbow, and the snuffbox, at the base of the thumb at the wrist. Sometimes, such as when the barometer drops, these areas can be sensitive to direct ice massage. You will experience an intense “nerve” ache. Try an ice pack instead. You can try an extra layer of a towel with your ice pack if needed. Another option is a “Karo Syrup ice pack,” which is not as intensely cold as the slushy ice pack.
For the neck, upper back, upper chest, and shoulder regions, you may use direct ice massage or the ice slushy ice pack 3-5 times a day. Additionally, alternatives for the neck and shoulder region, such as “Karo syrup ice pack” or “rice ice pack,” are helpful.
See my article, Ice Slushy and Other Cold Therapy Options for Pain and Swelling, for ice slushy, Karo ice pack, and rice ice directions and other cold therapy ideas.
Short Cuts & Tips for Real Life
Short cut on ice cup/direct ice massage for wrist or hand: Use a medium size/weight towel. Peel the cup totally off the ice. Turn the ice bottom side up on a towel. One towel and one ice cup will be sufficient for each a.m. and each p.m. Use every opportunity to rub your finger or wrist over ice. The ice cup is always ready. If you don’t get much chance to use it, no harm. One standard towel will keep the ice block from puddling for about 4 to 5 hours.
Icing at work: Take ice packs to work with you, especially if you work at a desk. My clients have confirmed that it is possible to get in 1-3 icings a day at work. The issue is not being so much busier than the rest of us desk workers that you can’t squeeze it in. The issue is getting a good mental strategy. Plan when and how.
Use a cut-off sock, ace wrap, or commercial wrist or elbow wrap to hold your ice pack in place, and continue to ‘drive’ your desk! Use a “splint sock” to hold a snack bag-sized Karo syrup cold pack against your wrist or thumb. Take a tube sock and cut off the toes. This is where your fingers will go. Cut a slit for your thumb. The leg portion of the sock will hold the ice pack against your wrist.
More icing at work: In my therapy clinic, I used a large cold pack in a pillowcase on myself. I would throw it over my upper back and upper chest on one side, tuck the excess pillowcase under my arm so it wouldn’t slip off, and continue typing at my computer. The weight of the large cold pack helps it stay in place. The same is true for rice ice and commercial synthetic ice packs. You could also try putting the ice pack in the hood of a hooded shirt for the neck/upper back region. Another strategy is to use a slightly tight tee shirt to hold your ice pack in place on the neck and shoulder region.
For icing multiple parts: I frequently asked my clients to try icing distally, to the wrists, forearms and/or elbows, as well as proximally, to the shoulder, neck and/or upper back. This is because the cause of the distal pain was often proximal, despite the client only feeling distal symptoms. Many clients have been surprised that icing their neck was more effective than icing their elbow for their elbow pain! Same for wrist etc.
Icing both distally and proximally could be a lot of icing, especially if both arms have symptoms. I always recommend shooting 3 to 5 times a day, but in these cases, I suggest balancing time between distal icing (hand, arm, elbow) and proximal (shoulder/neck/upper back). Over time, your body will tell you what combination is giving you the “biggest bang for your buck.” That is, whether icing your hands or arms versus your neck or shoulders gives you the most relief.
Ice is an inexpensive but invaluable tool in managing swelling, inflammation, and pain. Hopefully, now you have a better understanding of the benefits of ice, as well as some options and tips for making it easier to comply. You will be in a better position to discuss cold therapy options with your doctor or therapist. Educate if necessary!
Talk to Your Health Care Provider
This article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Consult your doctor. Consider asking for occupational therapy or physical therapy consult.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: Will ice help the pain of a broken rib?
Answer: I'm not sure, but there is absolutely no reason to think it would make it worse. That's my guide for recommending to try it!
Question: Will ice help gout pain in a big toe?
Answer: Unfortunately no, in my experience. I have tried various relief strategies for clients with gout. Unfortunately, patients reported nothing really made a difference. They felt that they finally got relief through meds when their blood chemistries finally returned to a better range. If I were going to try a strategy, I would try contrast baths, not ice. This is my article for contrast baths for hand pain and stiffness, but you would follow the same method for your feet.
Question: Will ice help a broken rib?
Answer: It may or may not help, but it definitely won't hurt. So try it!
Question: Is it good to put ice on a possible broken toe?
Answer: Ice is good for any pain and/or swelling in the arms or legs (and hands and feet).
Arjun P Sharma on November 12, 2015:
A brilliant read with lots of practical applications. Have linked to it from my hub :)
rmcrayne (author) from San Antonio Texas on February 13, 2013:
Yes Rose Anne, but you'll know next time to ice, ice, ice, as long as you have pain and/or swelling.
Rose Anne Karesh from Virginia on February 13, 2013:
I wish I had read this 2 weeks ago, I was given standard advice to ice for 48 hours but it sounds like I could have gotten quite a bit more pain relief if I had kept going!
rmcrayne (author) from San Antonio Texas on January 13, 2013:
I don't know sally, sounds to me like the moral is, doctors don't know everything. :-)
Sally Gulbrandsen from Norfolk on January 13, 2013:
Wish I had read this three weeks ago when I broke my nose falling off a chair. It also left me with terrific bruising on one side of my leg and foot and not once in the three consultations I had with doctors was ice ever mentioned. The moral of the story is, never think you are safe standing on a chair.
Mona Sabalones Gonzalez from Philippines on December 01, 2012:
Very nice. I will definitely explore the wonders of ice for my pains, as they tend to be plentiful. Thank you for sharing:)
SarahJayne123 on October 30, 2012:
Great hub rmcrayne, I injured my ankle 2 years ago and am still suffering with it. I've been advised to have surgery to correct it, has anyone had this? I found some information on this website http://www.newhallhospital.co.uk/treatments/foot-a...
Nancy McClintock from Southeast USA on May 11, 2012:
Great hub I published a link on my hub page. Thanks vote up
rmcrayne (author) from San Antonio Texas on November 23, 2010:
Thanks Dave. Ice is totally under-rated don't you think?
Dave Sibole from Leesburg, Oh on November 20, 2010:
A lot of good advice. I used to work in a fast food restaurant (Long John Silvers) and burns were frequent. Using ice was one of the first things I was taught. Great Hub.
rmcrayne (author) from San Antonio Texas on August 29, 2010:
Thanks for visiting xres55. I like teaching about icing and cold therapy, because it's so easy yet so effective.
xres55rummerxr on August 28, 2010:
Another high quality hub, congrats rmcrayne. I especially enjoy how you continue to reply to comments even almost a year after publishing this hub. Definitely top marks.
rmcrayne (author) from San Antonio Texas on July 25, 2010:
Thanks so much for your comment winterz! I'll be sure to pass along your ice endorsement for gout. I bet you'd love the Karo cold pack.
winterz on July 23, 2010:
Another thing I used ice pack treatment for was gout attacks. I always found it so soothing and it definitely helped with the inflammation. Ice is my friend!
rmcrayne (author) from San Antonio Texas on April 23, 2010:
Thanks JTrempe. I have bookmarked your website.
JTrempe from CA, USA on April 18, 2010:
Thank you! Thank you! What a great article! I am a physical therapist that tells people all day long "ice is your friend!" Too often people (even doctors!) jump into using heat only to get worse. If you have any pain use ice! If you only have stiffnes, you may consider heat.
For more free information about joint pain information and treatment recommendations, visit:
rmcrayne (author) from San Antonio Texas on February 01, 2010:
Money thanks for reading. I'm thinking the problem with your Naked hub was an automation thing? Maybe once a live HP staffer looked at it, it might not require any changes?
Money Glitch from Texas on January 29, 2010:
Hi RM, I stopped by to read the information that you mentioned to me. I found this and another hub on ice packs that I think will go nicely with my topic. There is a lot of good information here. I just wanted to let you know that I have included a link to this hub on my Butt Naked Ice Swimming hub. Thanks so much for allowing me to reference it. :)
rmcrayne (author) from San Antonio Texas on November 23, 2009:
I really appreciate your feedback paul. I would be tickled if you would use my hub with your patients. I'm a hardcore ice advocate, and tend not to take no for an answer on icing from my patients. I tell them not to be ice weenies. Over the years I've developed a fairly successful sell/speech. Let me know if it translates in writing to be persuasive!
paulthomley from north alabama on November 22, 2009:
As a Nurse Practitioner specializing in Chronic Pain Management, I am frequently recommending ice therapy for my patients, but it's like you point out--many people are reluctant to try ice, thinking that it will make their pain worse. My patients who have given ice treatments a fair trial have become believers. The others--I plan to refer them to your hub--maybe they will at least give it a try, and hopefully it will be helpful. While we cannot expect it to help with every different type of pain, it does indeed provide relief in many cases, and as a pain specialist, I'm always looking for different (non-narcotic) treatments. Thanks for this very educational hub with great, helpful information!
rmcrayne (author) from San Antonio Texas on November 15, 2009:
Thanks for reading Jen. You have to be careful with cold for MS. I recommend the Karo pack, in the frig, for short periods starting out.
Jen's Solitude from Delaware on November 15, 2009:
This is great info. I am one of those people who feels ice isn't good because it doesn't feel good. (smile) I understand better now why my thinking is faulty. My husband is an ice enthusiast, he will be glad to hear I have come around. Thanks for the thorough information that helps convince us skeptics.
rmcrayne (author) from San Antonio Texas on October 06, 2009:
Heat, oopsie! Ice packs or contrast baths would be good. But for feet, consider that you need to be off of them more. When I can't (or won't) shut my brain off, and am up round the clock, I definitely have some swelling. So if you can't shut down, to sleep so that your feet are level with your heart, consider at least sitting with your feet elevated. You can also put a large book between your mattress and springs to elevate your feet while you sleep.
lyricsingray on October 06, 2009:
I needed this today. My feet have been swollen really badly for over a week and I never thought to try ice - I've been using heat- probably why they're still swollen LOL Thanks I'll try the packs of frozen vegetables, K
rmcrayne (author) from San Antonio Texas on September 22, 2009:
Thanks for your support Wordscribe.
wordscribe41 on September 22, 2009:
Thanks, RM! I'll be looking forward to your upcoming hubs. Good luck with the HubMob.
rmcrayne (author) from San Antonio Texas on September 22, 2009:
Most PTs are adamant about ice for extremities, as am I. One of my favorite PTs said she was much more flexible about backs. She usually told her patients to do whichever felt better. I know chiros however that go with ice. That said, most therapists and some chiros will apply heat to ready patient for treatment, then ice after.
We used to think heat for arthritis, but now there are enough studies to recommend ice instead. I do direct ice massage for my knees. I would however exclude hands from this. I just don’t see ice helping with stiff fingers. I recommend contrast baths for hands.
I will be doing a hub on contrast bath alternatives, such as alternating warm and cold packs or compresses. I also have a half-done hub on heat treatments. This week’s HubMob topic seems to be pulling rank on everything else though!
wordscribe41 on September 22, 2009:
Another great hub. I agree about the whole "ice then heat" irritation. I've always used ice alone for my big swollen knee. I do wonder, however, when is it advisable to use heat? My back likes to act up a few times per year and heat feels SO good. Do you think it's advisable to skip the heat altogether? I have lower lumbar issues leftover from an old back injury when I worked in a hospital. I lifted someone improperly and my back has been SCREWED ever since. Anyway, your two cents?
rmcrayne (author) from San Antonio Texas on September 12, 2009:
Thanks AppleTree! So glad you think the info may be helpful. Stay tuned, I will be publishing a follow-up piece in the next couple days with my alcohol and water ice slushy ice pack and Karo syrup cold pack "recipes".
Appletreedeals from Salisbury, Maryland USA on September 12, 2009:
Great information - very useful as I have ballet-dancing daughter with frequent back/knee issues, thanks