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March 29, 1992|MARLENE CIMONS | Cimons covers health policy for The Times from Washington

The 38-year-old woman on a ski vacation was taken to the Orthopedic Specialty Hospital in Salt Lake City last winter after an accident. Her knee was a mess.

After surgery to reconstruct the ligaments, the knee was wrapped in a pad that was attached to a machine by a hose. The device circulated ice water continuously into the hose and through the pad--the equivalent of a giant ice pack.

Dr. Brian Victoroff, one of the orthopedic surgeons involved in the operation, remembers visiting his patient the next morning to ask if she was receiving enough medication for her postoperative pain.

Her response did not surprise him, for he had heard it many times before. "I haven't needed any," she replied. "This ice thing has been enough. It's wonderful."

The woman had learned what orthopedic surgeons, physical therapists, sports medicine specialists and professional athletes have known for years: Ice is a wonder drug.

It promotes healing, relieves pain, has no toxic side effects, costs almost nothing, and doesn't require a prescription. And it's as close as the nearest freezer.

The only problem is, for most people, its wondrous medicinal effects have remained undiscovered.

"Ice is extremely powerful," says 1972 Olympian Jeff Galloway, who has suffered more than his share of running injuries over the years. "Very few people either know about it, or use ice the right way. But maybe it's too simple and too obvious."

"People don't use it enough," says Dr. Ken Fine, an orthopedic surgeon/sports medicine specialist at George Washington University Medical Center. "I see a lot of patients who could have made themselves feel a lot better if they had used ice first before doing anything else."

It's understandable, though, how the therapeutic value of ice could go against a person's basic instincts. The thought of a hot shower, after all, seems more soothing than a bag of ice. Warmth is comfort. Cold is something else again.

But the next time you twist your ankle or your child bumps her head, resist your first impulses, experts say.

"We often have patients come in from the ski resorts with acute injuries and a great many of them say: 'I tried soaking it in the hot tub and it just made it feel worse,' " Victoroff says. "They are often quite surprised to find out that we recommend just the opposite. It would have been much better if they had stuck it in a snow bank."

To understand why ice works, it is necessary to know what happens when an injury occurs. After a strain, inflammation usually follows. Blood vessels at the site of the injury expand, a process known as vasodilation. This causes pain and swelling, and the accumulation of fluid, or edema. At the same time, the body also releases certain chemicals to try to protect the injury--but this also causes more swelling and pain. And some blood vessels may also hemorrhage.

The immediate application of ice reduces the swelling, which also curbs the pain.

"Ice is probably the best, quickest and cheapest anti-inflammatory out there," Victoroff says. "It reduces inflammation by preventing swelling, by reducing blood flow to the site of the injury. And it may also prevent the cells from releasing substances that produce pain. It also reduces bruising by decreasing the blood flow, not just under the skin, but within the ligaments, etc.

Experts also believe that ice may act as a painkiller in another way, as a counterirritant--much the same as acupuncture, acupressure, massage or ultrasound. These create a superficial stimulus over the pain area--they do not heal or cure the injury in any way--but "create a pathway different from the pain stimulus--the injury itself--and may block the transmission of the pain stimulus," Victoroff says. "It's called the 'gate-controlled' theory of pain control."

Heat, on the other hand, raises tissue temperature, causing muscles and ligaments to become more flexible, and increases circulation--which can cause more swelling and pain. It may magnify the inflammatory response.

In some situations, heat can be valuable--but only several days after an injury has occurred and the swelling has subsided. By then, an increase in circulation can accelerate the removal of waste products--the debris of dead cells at the site of the injury, and chemicals produced by the inflammatory response--and increase the supply of oxygen. The key is knowing when to use heat. Most experts advise: When in doubt, stick to ice.

Ice is effective both on acute and chronic injuries. It is routine for athletes with a recurring problem--tendinitis, for example--to ice the area immediately after exercising. This keeps the problem from getting worse and enables the athlete to keep on exercising.

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