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I think when most people hear the words “put ice on that” it carries about the same weight as “drive safely”- in one ear out the other.  I have many patients with injuries where icing is appropriate.  When asked how many times they have iced their injury since I saw them last, they quickly divert their gaze to the floor and uncomfortably begin the report of why they didn’t have time or forgot.  I can definitely identify with the lack of time excuse, but if you consider the amount of time put into training, an additional investment of 15-20 minutes is worth it when you consider that one possible alternative is not being able to run at all.  This is especially true if the involuntary down time causes you to miss a race that you’ve already paid for.

Last week I had to do part of a run on a treadmill.  I normally try to avoid treadmills as much as possible but the roads were covered in snow and my training plan had me incorporating some long intervals into my work out.  I figured the treadmill would at least provide consistent footing.  About 15 min after finishing my workout, I started noticing that the ball of my right foot was becoming more painful.  My left calf was also starting to feel irritated as well.  Citing the ‘lack of time’ excuse, I didn’t ice these painful areas that day.  The next morning when I first stood up I could barely put pressure on my right foot and my left calf was so tight that it was causing heel pain.  Throughout that day, I was able to put ice on the ball of my foot a couple of times.  The discomfort decreased but never went away.  I managed to get through my run for that day without an issue, but by the time I got home a significant amount of pain had returned to the ball of my foot and calf.

ice bath

Instead of trying to put ice packs on all the painful areas I decided to hit everything at once with an ice bath.  I filled a 5 gallon bucket about 3/4 full with cold water and stuck my feet in.  Once over the initial shock of the cold water from the tap, I started dumping snow (since this is currently an unlimited resource at my house) into the bucket, filling it to the top.  Anyone wearing a shoe larger than men’s 10 will not comfortably be able to use a 5 gallon bucket, I could just barely keep my feet flat and the water only covered about 2/3 of my calf.  Don’t worry about trying to push the ice/snow down to the bottom, cold water sinks and you’ll quickly feel the colder water hitting your feet.

There are several progressive sensations that you should experience with cryotherapy (ice packs included).  The first is obviously cold, however adding the ice/snow after your feet are in the water makes this stage much more bearable.  The second sensation is going to be an aching/burning type of pain…a moderate ache that’s fairly uncomfortable sets in to the feet first, then the calves.  It’s important to remember that you don’t get the full physiologic benefit until after this stage, so try your best to tough it out.  After about 10 minutes, this passes as your feet/ankles/calves begin to feel numb.  The general recommendation for cryotherapy to reduce pain and swelling is 15-20 minutes.  Remember, more is not better, beyond 20 minutes there is the risk of frostbite and there’s an opposite effect of increased blood flow which can worsen the swelling.  I make sure I’m in a situation where it’s not necessary for me to walk for another 10-15 minutes after taking my feet out of the water…unless my house was on fire, I don’t think I could anyway.  I elevate my feet and let them regain sensation for about 10 minutes and the feeling to them has usually fully returned within 20-30 minutes.

The next morning, as I stood up anticipating pain, there was none at all!  Not only was the pain gone, as an added bonus my lower legs and feet felt much better overall!  Even after my 18 mile run last weekend, the pain in the ball of my foot did not return.  However, just for preventative measures I decided to do the ice bath right after I got home.  The whole process of soaking my feet/legs in ice water has become easier each time I’ve done it.

Small aches and pains can usually be stopped with icing before they become larger problems.  If icing doesn’t seem to be helping after several applications, there may be a larger underlying problem, that’s when you may want to have it evaluated by someone.

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