When and Where to Avoid Ice

Many areas of the body are not well endowed with sufficient muscle or fat, such as the foot, ankle, kneecap, and elbow, and the use of ice has greater potential to cause harm in these areas. Some of these regions also contain large nerves. The overenthusiastic use of ice can literally freeze these nerves, along with the skin and small blood vessels, causing additional serious injury. Essentially, cryotherapy can result in frostbite unless ice is applied with caution. Also avoid ice on areas of reduced sensation, which may exist as part of an injury, because you won’t know the ice is hurting if left on too long.

In some individuals, ice should be avoided because it can cause further damage. Those with rheumatoid arthritis, Raynaud’s Syndrome, or any type of paralysis should not use ice.

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A small number of people have cold allergies, and ice can cause adverse reactions. Most people already know the condition exists because of previous adverse reactions to cold, including pain and skin rash. Those with high blood pressure should also be cautious when using ice as it can raise blood pressure.

Care should be taken in using ice boots or other strap-on ice packs because these are often used for too long. They are frequently used for convenience allowing the person to be active during cryotherapy—itself a reason to avoid them, since rest is most often what is required. Do not put these devices on before going to sleep as they can over-treat the problem.

For acute injuries, especially during the first twenty-four hours, ice is the preferred therapy, but certain remedies should be avoided. These include the use of heat in any form, whether a hot bath, heating pad, or heating gel. Heat can aggravate inflammation. An aggressive massage can also create heat and should be avoided. Differentiating between the need for heat or cold is relatively easy: If an area of injury is warmer than the rest of your body, cool it; if it’s cold, heat it. In general, cooling is the best therapy for acute problems.