20 Questions about cooling

1. What is “cooling”?
Cooling is a collective term for a number of First Aid measures applied with injuries. There are many names for what is usually called “cooling”. The most common ones are listed below:
• cold therapy
• cryotherapy (Kryios is Greek for “ice”)
• ICE is an abbreviation, meaning Ice, Compression and Elevation.

2. With which injuries should cooling be applied?
Cooling can be applied at sprains, bruises, or ruptures. Actually, you can use cooling with any kind of injury. Only in the case of an open wound or bone fracture, cooling should be omitted. When cooling around the eyes or genitals, one should be extra careful.

3. Until now, you have only mentioned acute injuries, right?
Yes, indeed, but cooling can also be used to slow down the inflammation and ease the pain that are part of a, starting, overload injury. But in this case, you still have the risk of thinking the problem is solved and continue heavy training. When suffering an overload you will always have to reorganise your training schedule into a less heavy one. Cooling can be used, though, as a means of support after light trainings and in the recovery period.

4. What is the purpose of cooling?
Cooling is the best remedy against swellings, caused by fluid and internal loss of blood. Main purpose will be providing a quick answer to the unavoidable inflammation. By cooling treatment, the blood vessels will “shrink” (vasoconstriction) and it is prevented that more blood will flow into places it does not belong.

5 What is to be achieved?
By controlling aforementioned body reaction, recovery time can be seriously reduced. After all, a swelling that does not develop any further does not have to be broken down by the body. Besides, cooling also has the nice effect of reducing the pain.

6. What is the best way of cooling?
Cooling is done best by means of a cold pack.

7. I beg your pardon?
A cold pack is a synthetic bag filled with gel. You can place it in the freezer to let it go cold.

8. So when needed, you can just put it on the pain spot, straight from the freezer?
Absolutely not. If you put a cold pack directly to your skin, freezing symptoms will occur. Blisters will appear on your skin and damage will only increase.
When using a cold pack you should always place a towel between cold pack and skin. The easiest to work with would be a face cloth. Quite often, a special cover will accompany the cold pack you buy.

9. Is there only one kind of cold pack?
No. You can also find combined cold - hot packs. This kind of bag can be put in the freezer, as well as in hot water or the microwave. You can use the hot pack, for example, in case of a cold on the muscles. You can also find differently sized bags. There is even some kind of pack that uses a chemical reaction to become cold.

10. That does sound very easy, but what if you do not have a freezer at hand?
It is always possible, during preparation, to cover a cold pack in an isolation bag and take it to the training grounds or competition.

11. You don’t seriously think I would be dragging along this bag all day, do you? I want to keep it fun, you know.
If all is well, every clubhouse has a cold pack ready at your disposal. But most of the times that you are exercising outside, you will not have a cold pack with you. In that case, you will just have to go with the alternatives.

12. What are those alternatives?
The simplest would be ice cubes from the canteen. Crush these in a plastic bag and you have made yourself a cold pack. For small injuries, you can also put the ice cubes in a plastic cup. By drawing circles on the injured spot you will cool it considerably. Slowly running cold water from a tap or ditch can well be used as a means of cooling, too. The cold water should best touch your skin somewhat above the injury. If all this is nowhere near you can even try cooling with an ordinary ice cream. Be sure to buy a horn, at least you will be able to keep your hands clean. Of course, you should be extra on the lookout for stingy insects like wasps.

13. I remember to have seen this kind of cooling aerosol sprays?
The use of such aerosols with chlorine-ethyl seems to be an easy solution, but you better leave it to specialists. The risks of freezing are simply too big.

14. When should you use cooling?
Best would be right after the injury occurred.

15. How long should you be cooling?
Fifteen to twenty minutes at max. Continuing treatment any longer would cause the body, wanting to fight the cold, to start a counter reaction that sends extra blood to the place. And that of course is just what we were trying to avoid.

16. So cooling once would do the trick?
No, cooling only once is not enough. In principle, you can repeat treatment once every hour for the first forty-eight hours. Of course, while sleeping you can hardly continue treatment. After this period, cooling is useless. Effect will be greatest in the first few hours. So repeating at least four or five times will make the swelling go away, more treatments only ease the pain.

17. What exactly is meant by “pressure” and “keeping elevated”?
“Pressure” is when you use external pressure, for example from pressure bandages, to fight any swellings.
The “keeping elevated” of your leg by putting it on a chair or of your arm by wearing a sling can decrease recovery time because, by gravity, less blood will flow towards the injury. That will cause a reduction to your swellings. Cooling thoroughly is still the most important.

18. If you twist your ankle, should you take off your shoes before you start cooling?
It depends on how careful you are to your shoes and to what height it encloses your ankle. In principle, shoes serve well as a “pressure bandage”. Especially if you still have to walk some distance, you better keep your shoes on. If you take them off you probably will not be able to put it back on, because the ankle gets too much swollen. The combination of cold pack and shoe does not work. You will only be able to do some cooling with cold (ditch)water.

19. Is cooling only useful in the case of sports injuries?
No, I feel that every household should keep a cold pack in the freezer. Everyone bumps his head, arms or shinbones from time to time. With every bruise you can limit its size and reduce the pain by immediate cooling.

20. If you do your cooling well, could you start training right after?
If injuries have developed you have to find out which alternative trainings there are that do not worsen your injuries. This is very important so as not to drop the level of your overall condition. Only once all pain symptoms have disappeared during or after your workout, when strength has fully returned and agility is the same again as that of the other limb, you can say you are ready to return to your usual training schedule. The competitions will have to wait for another few weeks or months, even. It is important to look for professional advise on the more serious sprains and other severe injuries. A doctor or physiotherapist can tell you exactly what you should and what you should not do.

Live Long and Prosper!