The old adage of the profession of athletic training is “ice er’ down”. This comment is both simple and can seem to the patients/parents/coaches that you are not doing enough. However I am here to tell you that hypothermic treatment (ice) is EXTREMELY beneficial for just about every* injury we see for the basic principle of; slowing the metabolic response to injury.
When there is an insult to the body the immediate response is a metabolic reaction – in other terms the body uses chemical and mechanical pathways to repair/fix itself. Although the reason for the metabolic response is thought to be for “repair” the body response is usually not limited to what is needed – the more is better philosophy. chapter in a book called “Principals of Surgical Care”.
Subsequent medical research has shown that attenuating the metabolic response has; decreased pain, shunted swelling, and improved outcomes, especially in a very narrow window after injury. The least invasive and easiest way to accomplish this is via hypothermia (see heat related illness). Cooling the body, even locally, can attenuate the metabolic response and the negative effects it has on recovery. That is why you will hear athletic trainers tell you ad nausea to “ice ‘er down”. The reason is simple we are helping you AND YOUR BODY recover faster.
Cryotherapy, or the use of ice, for sports injuries has been the accepted practice for decades. I was taught, like many other health professionals, the old acronym RICE (Rest, Ice, Compression, and Elevation). The basic science behind the practice seems simple enough, but research on the topic has yielded mixed results. Here are some of the generally accepted physiological reactions to icing:
Reduces pain by slowing nerve impulses.
Reduces swelling by decreasing capillary permeability (less fluid escapes from bloodstream into tissues).
Decreases spasm by inhibiting involuntary muscle contraction.
Decreases secondary cell death after injury by lowering surviving cells’ need for oxygen.
Because of swelling and congestion in the area, surrounding healthy cells can be damaged due to lack of oxygen after injury.
Ice can penetrate up to 2 inches into the injured tissues.
Evidence shows that cryotherapy slows metabolic processes and nerve conduction velocity. Metabolic pathways are necessary for human function. Cells are supposed to produce catabolic and anabolic reactions. This is a constant process in all humans. During healing we breakdown and rebuild tissue. Cold inhibits this function, so in a sense we are slowing the necessary catabolic and anabolic pathways.
Posttraumatic brain hypothermia reduces histopathological damage following concussive brain injury in the rat..
Neuroprotective mechanisms of hypothermia in brain ischaemia:
Cooling can reduce primary injury and prevent secondary injury to the brain after insults in certain clinical settings and in animal models of brain insult. The mechanisms that underlie the protective effects of cooling also known as therapeutic hypothermia are slowly beginning to be understood. Hypothermia influences multiple aspects of brain physiology in the acute, subacute and chronic stages of ischaemia. It affects pathways leading to excitotoxicity, apoptosis, inflammation and free radical production, as well as blood flow, metabolism and bloodbrain barrier integrity. Hypothermia may also influence neurogenesis, gliogenesis and angiogenesis after injury. It is likely that no single factor can explain the neuroprotection provided by hypothermia, but understanding its myriad effects may shed light on important neuroprotective mechanisms.
European society of intensive care medicine study of therapeutic hypothermia (32-35°C) for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235Trial)
Traumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union.
Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1°C/4 hours).
Traumatic brain injury (TBI) is a major cause of death and severe disability throughout the world. TBI leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people . Additionally, TBI causes 290 000 hospital admissions, 51 000 deaths and leaves 80 000 patients with permanent neurological disabilities in the United States annually . The consequence of this is both a devastating emotional and physical impact and an enormous financial burden.