Eh? How do injured cells lose blood? Or fluid for that matter, without dying? Bleeding generally isn’t a major issue in most soft tissue injuries and an ice pack the next day isn’t going to affect it much. Compression immediately postinjury would be much more helpful in that regard.
Well, actually that is sort of the rationale behind icing an injury. Inflammation is important for wound healing for a number of reasons but it also tends to injury or kill healthy tissue nearby. This is less than optimal but also totally normal. There’s a balance to be struck between too much and too little but a lot depends on the nature, location, and severity of the injury, what type of tissue is involved, how cold and for hold long, etc. It’s also not as simple as cold=decrease inflammation and blood flow. Superficial cooling in over a small area can actually result in increased local blood flow. Cooling past a certain level can actually increase inflammation.
There’s plenty of literature that shows deleterious effects of cryotherapy in animal models. Systemic reviews of the use of cryotherapy in soft tissue injuries mostly show the existing literature is inconclusive and generally of poor quality. What’s not controversial is that if you sprain an ankle, icing it will often make it hurt less and there’s no convincing evidence that it does any harm (no real evidence it does any good either, except perhaps in the first few days). A minor sprain will heal just fine almost no matter what you do so you might as well make yourself comfortable.
there are so many variables that we understand (those of us that research cryotherapy) and possibly many we haven’t thought of that I’m inclined to conclude that a standard procedure for icing an injury cannot and should not exist.
the best solution I can see would be to allow your body to do it’s thing, applying ice as you feel you need it, or, ideally, consult an expert in the field and determine an icing strategy.
god I wish the world didn’t run on paper currency so we could do awesome things like optimized cryotherapy for everyone
Injured cells do die. Capillaries eventually are only one cell thick, allowing the exchange between arterial and venous blood. So it’s not correct to say that blood/fluid loss is not a problem - it is. Cooling and elevation both help, and compression if used very soon after the injury helps as well. It is no surprise that systematic reviews of the use of cryotherapy in soft tissue injuries mostly show the existing literature is inconclusive and generally of poor quality. That’s what most systematic reviews show about just about anything. However, all in all it is my opinion that when one considers the fact that currently ice is advised for only 15 minutes every 4 hours, it is now generally held that it is of much less benefit than once believed.
My quibble was was with your claim that blood and fluid are lost from injured cells as opposed to blood vessels or tissues. Capillary wall thickness has no bearing on its transmission of blood from artery to vein. They could be 20 cells thick and it would still transmit blood just fine. (This isn’t hypothetical. There are various shunts that do exactly this in various tissues.) It does have bearing on it’s ability to allow diffusion into the interstial space. Blood loss is a consequence of injury but elements in blood also trigger the healing process. The fluid “loss” isn’t due to vessel injury but is mostly due to the inflammatory mediators released in response to injury. And this is intentional! This allows migration of normally blood borne cells into the interstitial space to allow for wound healing. I’m not sure what you are trying to say re: blood/fluid loss.
I don’t think anyone is arguing that ice might have a small short term effect on pain and perhaps early mobilization. Do you have any evidence it makes any difference in the medium to long term? A cite would be nice.
Huh? First of all that’s a bizarre criticism of systemic reviews but that’s wandering off topic. Are you claiming you think there’s evidence that cryotherapy has a meaningful effect on long term outcomes in soft tissue injury? Cites please.
Cite for the fact that ice 15 minutes ever 4 hours is some sort of standard? Most cite a desire to avoid frostbite as the reason that intermittent icing is used. Are you claiming the idea is to make the injury just intermittently cold? The reason there have been dozens of papers published on this topic in the last decade alone because there are at least some who believe that cryotherapy is either useless or harmful. I’m not sure I understand what your position is?