Ice and water - Friend or Foe

I have noticed a lot of EM sufferers advise against ice and water soaks . I’d like to put out a more moderate idea for discussion . Working as a physiotherapist ( though no longer able) ice is a useful treatment for inflammation wether arthritis or an ankle sprain . There are however some strict guidelines
. Always wrap the ice pack in a damp cloth - otherwise you risk a cold burn
.apply for no more than 10 min at a time . The general idea is NOT to reapply the pack until the red of that episode fades - that’s a bit of wishful thinking I know . I wait 20- 30 min between applications.
. Do not use ice if you have peripheral vascular disease or reduced sensation
.A packet of frozen peas covered with a thin cloth is often cold enough , ( straight ice is colder )

These guidelines are conservative and I my opinion they have helped me greatly .

Cold water soaks - these depend on skin condition and general dryness - but a couple of 20 min soaks a day have been fine in my experience . I always apply lotion after ,particularly as I like to add some Epsom salts to the water .
I think moderation is the key, and that problems arise with overuse , as tempting as I know it may be!! There is no reason to think that ice at these levels should damage nerves or cause ulcers .
Would be interested to hear about others experiences with ice and if this sets anyone’s mind at rest .
Cheers Tizzy
( if anyone has any questions about swelling , stifness or other physio stuff I can share my general knowledge and what works for me - as always check with your own Heath professional as they know your full medical history )

Our dermatologist pointed out that the cooling down process, especially with ice causes the capillaries to restrict but as soon as the feet are removed from the cold they have the opposite reaction the the removal of cold therefore worsening flares and over time increasing risk for tissue damage. Thoughts?

The onlt relief I have found is to soak in ice water. I too was told that this causes the capillaries to restrict and can cause damage over time. I still soak my feet in ice water as sometimes the desperate pain I'm feeling is too much. I would love to believe that it does not cause any damage but until there is a better way I will take the relief at any cost.

For me the biggest problem is it is too much to use long term without causing damage. If I am in a situation causing me to flare I can use the ice sure ,for a 10 minute relief but when I take it off I am still in that situation and I just start flaring again because That part of the body is exposed to the heat again. That's why I tend to reach for chilli pads because they work through evaporation and draw the heat out of the skin and not try to cool the skin itself. I can use the chilli pads non stop for hours if need be.

I also tend to get it all over my body so I can wrap one on my arms and also have one wrapped on my feet all while also having one wrapped on my hands and apply that to my face! All of that and I can sleep wrapped in these things if I have to. For the most part now days I simply avoid warm places and stay home in my AC for the most part.

I don't see any harm if using Ice the right way brings you relief and you don't have a reactive flare like some. It just doesn't fill my needs. It's more of a teaser for me just to have the comfort taken away after 10 minutes!

The best of luck finding the right thing that helps you.

Take care,


What about elevating the feet as an alternative to putting them in cold water? It works for me as long as they are elevated quite high. Can doing that cause any harm?

I've read prolonged immersion of the feet in coldish water can be harmful. I realise that's not what you were suggesting, but I thought I'd mention it since it seems like the natural thing to try (it's what I did for a while at least).

I put each foot in a gallon zip-lock bag, part;y zip them to make them stiffer so they don't fall into the water, put water to my ankles in a pan/small cooler, with just a small amount of ice to keep the temp at 60 degrees (get a little thermometer). It isn't too cold. My feet feel wonderful. No freezing or water-logged skin. You can put lotion on before putting them in the bags (I wash and reuse).


Hi Tizzy, this was very informative, thank you!
I try to keep my ice packs wrapped in a dish towel, but gotta admit, when I am in a crazy flare I cannot stay patient enough to wait for the cool temps to come through that darn towel! Often I reach for a can of cold soda to hold. Probably not ideal, but I’m also not holding ice cubes (much worse!). Your thoughts?

Be great!


I've managed to find the document I read about cold water immersion. Here's a link so you can see what you think:

Here's couple of snippets (NFCI stands for 'non-freezing cold injury'):

1.3.3. Trench foot follows protracted immersion in cold water, usually at 0°C to +10°C,
which gives rise to prolonged peripheral vasoconstriction. Resultant ischaemia
and changes in cell function damage the blood vessels, nerves, skin, and muscle.
Clinically, NFCI appears to belong to a family of disorders in which there are
different combinations of ischaemia followed by hyperaemia and subsequent
sensitisation to temperature disturbance.

4.2. NFCI (trench foot) follows exposure to wet, cold conditions with ambient
temperatures above freezing. A typical duration of exposure is often quoted as 1-2 days,
but NFCI may result from exposures of less than 1 hour (e.g. immersion injury in very
cold water) to up to a week under less severely cold conditions. The severity of
trench foot is determined by the degree of cold, wetness of the tissue, the duration of
exposure, and individual variability.

4.2.1. Most authorities believe that NFCI is a vascular neuropathy and that intense and
prolonged cold-induced peripheral vasoconstriction is the most significant feature
in the aetiology of the condition.

Hi, My physio recommended rolling my feet on bottles of frozen water to alleviate the chronic pain I get in my feet constantly and help with stretching them (pain not from the EM) . I was skeptical because the physio admitted to knowing nothing about EM but I used it for a few weeks to try and get some relief, I rolled them on the bottles for a few minutes each twice a day and not when feet were flaring.!

Hi Tizzy,

Yes I wasn't disagreeing with you. You were advocating moderation, which seems good to me. Not that I would disagree anyway seeing as I haven't had EM that long, and I'm not any kind of expert.

I thought the doc was interesting to give some rational to why moderation is needed, and a few things it said were interesting.

It seems to says that over doing cold water immersion can damage the nerves and blood vessels, which I would have thought would be a big problem to us EMers.

Also I was quite surprised how quickly it can happen, at temperatures close to freezing just hours. It can still happen with warmer water up to 10 C, but takes a lot longer so I guess that would be much safer.

Hi tizzy, yes your correct that’s what they thought had caused my foot pain but after a while and a trip to biomechanics and other specialists was told that it was more likely to be due to whatever unknown thing was going on systemically. I later found out I had ms so now assuming it’s pain from that.! I have severe pain every day on top of the burning and tingling from EM.!

Drs ruled out MS in 2007/8? but at my recent neurology appointment my ms specialist said that I would’ve had it all those years ago but the clinical (measurable) evidence wasn’t there. Believe me I didn’t used to be very positive and I’m sure if you’ve read some of my posts you’ll see I’ve had some real down points but if have soon realised that having a negative attitude doesn’t help… Really hard at times I know… I have recently picked up on the exercise again after losing the motivation to do anything over 6 months ago. Exercise does cause flares as well as my pain levels to rise but so does working or doing housework so I reason (sometimes wrongly) that if I can do them then what’s stopping me running and riding my bike. I’m doing the couch to 5 k training at the minute, just coming up to week 5 sessions (in less than 3 weeks) and also trying to get back on my bike again at least once a week, I did a 2 mile run last night and a 8 mile cycle ride first thing in the morning… I used to be addicted to exercise and it’s really hard to HAVE to pace myself now. I understand that not everybody can do it but I want to while I can, I stick two fingers up to EM & MS whenever I fade which gives me motivation to not let it win.

Hi Tizzy,

Heck no, you don't come across as a smarty pants, just smart. I'm just learning so I rely on people who've got knowledge and are kind enough share it.

It's around this time last year my troubles first started. A year ago I was running most days, I sure do miss my health.