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From Fellrnr.com, Running tips
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The general recommendation for ice is to apply it for 20 minutes, then remove it for 20-60 minutes, repeating this cycle several times <ref name="x5"/>. The general advice is to avoid applying ice for too long as it can damage the skin. I have found while this approach does help a little, it is not as effective as leaving the ice in place for a much longer period.
==Longer Applications==
Does a longer period make sense? Well, a Study has shown that the time needed to cool a muscle varies with the thickness of the fat surrounding the muscle. To lower the temperature 1 cm into the muscle by 7 degrees C, it takes ~8 minutes of ice for 0-10mm fat, but ~60 mins for 21-30mm fat<ref name="x4"/>. This suggests that a simplistic 'apply for 20 minutes' guide is inappropriate; to impact tissue that is an inch deep would require at least an hour. One study<ref name="IceMassage"/> applied ice for 30 minutes and recorded the temperature at 1 and 2 cm into the muscle (below the fat layer). The results indicated that the minimum temperature was not reached during the application, but 6 to 9 minutes after the application finished. This suggests that 30 minutes was not sufficient to fully cool the muscle. Other factors to consider:
* Any barrier between the bag of ice and the skin will require a longer time period<ref name="IceTowel"/>.
* Massaging with ice requires less time to cool the muscle than passive application, but it does not result in a lower temperature<ref name="IceMassage"/>.
* Compression also reduces the time required to cool the muscle<ref name="IceCompression"/>.
==My Approach==
My personal approach is to apply ice for much longer; often for hours continuously. I find that this produces much deeper healing and I have never had any problems. However, there are a number of conditions that would make this approach dangerous, such as poor circulation, diabetes or arthritis<ref name="x3"/>. You should also be careful about applying ice for prolonged periods at joints such as elbow or ankle; the nerves are closer to the surface. I know some people like to use a compression bandage to hold the ice in place, adding compression to the cooling.
<ref name="IceTowel"> http://journals.humankinetics.com/jsr-back-issues/jsrvolume6issue4november/theeffectsofcryotherapyappliedthroughvariousbarriers </ref>
<ref name="IceMassage">Intramuscular temperature response... [J Orthop Sports Phys Ther. 1998] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/9549714 </ref>
<ref name="IceCompression">The Effects Of Ice And Compression Wraps On Intramuscular Temperatures At Various Depths http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317720/ </ref>
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