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 Bonnie Stein

          Bonnie Stein, M.Ed.

When In Doubt...Bring the Ice Out

By Bonnie Stein, M.Ed.

I received a frantic call Tuesday night before I left Florida for a week of racewalking lessons in Atlanta.  It was a new student who was scheduled for a two-hour lesson on Thursday morning.  She told me that she was having terrible pain in one heel and didnít know what to do so that sheíd be able to have her lesson in two days.

I asked my usual questions Ė Did she increase her miles too rapidly in anticipation of our lesson?  No.  Were her shoes too old?  No, she had them less than three months.  Had she done anything at all different from usual?  Well . . . maybe one little thing she had been doing for three weeks.  She had read in a popular magazine that walkers should add one minute of running to each walk to increase osteoporosis prevention benefits.

I told her to start icing her heel immediately, if not sooner. Ice five times each day, every two hours, for 20 minutes at a time.  No exercise walking until she is totally pain-free.  The culprit was that she was running (even for just a minute at a time) in walking shoes.  She had inflamed a ligament surrounding the heel.

We postponed her lesson for five days and she made a physician appointment for Thursday morning.  He agreed with our diagnosis and told her that the best thing she could have done is what she did Ė get ice on the heel immediately.

If you are going to run, then you must wear running shoes.  Walking shoes donít have enough shock absorption for the impact forces of running. Still, if you donít like running (and she didnít) you donít need to run since walking (at the correct intensity) can give you the same benefits as does running, minus the extra compression forces and possible injuries.

Have you ever felt an ache or pain and thought, ďOh, that will go away if I just take a few Ibuprophen and ignore it?Ē  Well, think again.  Donít make that mistake.  The below article is so important, that I hope you will memorize it.  Iíve never said that about any other article that Iíve written.  This is the most valuable information that I could give you for any injury that you may incur in the future. When in doubt Ė ice it!

"Ice or heat? Ice or heat? Hmmm, heat feels a lot better; I'll use heat." When trying to remember which action to take for a new injury and most overuse injuries, Dr. Perry Julien, a sports podiatrist in Atlanta, says,  "You can almost never go wrong with ice." He reminds us that heat on a new injury can be a big mistake.

Dr. Julien was called to the emergency room to see a patient who couldn't quite remember if ice or heat was the treatment of choice. The patient decided heat would feel better on his sprained ankle and had soaked his ankle in a whirlpool. By the time Dr. Julien saw him the next day in the emergency room, his ankle was so badly swollen that it was hard to tell if it was from the original injury or from the whirlpool. Treatment had to be prolonged until the swelling could be brought down, thereby significantly delaying healing.


Research confirms Dr. Julien's recommendations. Cote et al studied the effects of cold, heat, and contrast baths (alternately switching from cold to heat) for treatment of new injuries. Swelling reduction was achieved only by using the cold treatment on the first treatment day. A study by Hocutt et al also revealed the importance of immediately treating with ice. Patients who were treated with ice on the first day of an ankle sprain or the next day were pain-free and running after six days. Those who began ice treatment on day two went 11 days before they could run without pain. Yet, even waiting to use ice was still more productive for healing than using heat. The patients who used heat weren't pain-free until 15 days later. He concluded that ice is the treatment of choice and that waiting more than 36 hours after the injury to apply ice can delay healing significantly.


Dr. James DiIenno, a certified Chiropractic Sports Physician in St. Petersburg, Florida, explains what happens when we sprain an ankle or have a similar injury. "Tissue is stretched and torn, and swelling occurs. Swelling interferes with healing." Therefore, our goal is to reduce swelling and speed up the healing process. Dr. DiIenno says, "Cold shrinks the blood vessels, which reduces the bleeding in the area and helps to prevent swelling.

"Dr. Jeff Cohen, a USPTA professional tennis player in Boynton Beach, Florida, is also a chiropractic physician who lauds the virtues of ice in treating typical injuries that walkers would incur. He explains, "The body has checks and balances. A sprain or strain is your body's way of protecting you - essentially stopping your activity before you tear tissue." When you injure a muscle or ligament according to Dr. Cohen, "it means that you've gone beyond what that muscle or ligament can comfortably do.Ē


Dr. Cohen's system for using ice is to aim for CBAN. "C" (first the ice should feel Cold), "B" (next, you should feel a Burn), "A" (then, it should Ache), and lastly "N" (Numbness). Typically the whole process takes 10-25 minutes. Dr. DiIenno says, "areas with little body fat (like the knee, ankle, and elbow) do not tolerate cold as well as fatty areas (like the thigh and buttocks). So, for bonier areas, keep to the low end of the recommended application ranges."
People with more body fat would need to ice for a little longer, especially in the non-bony areas. Overweight people can use ice water immersion of the affected area for short periods of time, since this type of treatment cools the area very quickly and more effectively.


Any injuries with swelling and inflammation could benefit from cold treatment. According to Dr. Julien, most overuse injuries that walkers might experience are acute problems and would benefit from using ice. Ice is usually worth trying even if you feel muscle soreness after a hard workout. Why not reduce mild inflammation immediately and keep it from getting worse?

There are a few instances where cold treatment may be contraindicated - people with diabetes or another condition that can diminish blood flow should check with their doctors before using cold treatment.  Also, some people with Raynaud's Syndrome (a condition with which the blood vessels in the fingers and toes constrict dramatically when exposed to cold) might need to make adjustments in using ice therapy.


Often walkers who take my advice regarding ice don't follow through properly. I tell them to ice the first day of the injury and repeat the 15-20 minute process every 2 hours. Then, use ice on and off for two or three days. They think that's too cumbersome for their schedule, so instead of 5 times the first day, they choose to ice once, but keep the ice on for an hour or more. That's a big mistake.

After you've reached the numbness component of CBAN, your body thinks, "Oh, no. I might be getting frostbite.  I'd better heat up the area to protect myself." So, if you ice for too long, you're doing just as much damage (maybe more) than if you don't ice at all.

According to The Physician and Sportsmedicine, with a prolonged drop in temperature, a cyclical increase in blood flow occurs. "This vasodilation is thought to be a response to protect tissue." Since vasodilation is counterproductive to reducing inflammation, if you aim for CBAN, you'll have your own accurate barometer of how long to use ice or ice water. Twenty minutes of ice every two hours for three sessions is NOT the same as one hour of ice for one session. In this case - less is more.


Probably not, according to the experts. The same article in The Physician and Sportsmedicine looked at numerous research studies regarding heat and cold treatment of injuries. The article concluded that  "heating is contraindicated for acute inflammation," and that "heating should be reserved for chronic processes which are aided in increasing the extensibility of connective tissue, maximally increasing blood flow, or reducing muscle spasm.Ē

Many walkers have practiced the "ice for a new injury for the first 72 hours, then heat" method of treatment. According to the same article, very little data supports that type of treatment especially for inflamed knees or any inflamed joints.  Ice remains the recommendation for inflammation.

When asked if he can think of any reason to use heat, Dr. Jeff Cohen says, "If you're getting romantic with your spouse, I recommend the hot tub. Other than that, use ice.

© 2007 by Bonnie Stein. All Rights Reserved.

LIMITS OF LIABILITY AND DISCLAIMER - The authors and publishers of this newsletter have used their best efforts in preparing the articles and information contained within it. Additionally, you are advised to consult with your doctor before beginning an exercise program. The authors and publishers make no warranty of any kind, expressed or implied, and shall not be liable in the event of incidental or consequential damages.

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