What's the issue with icing for too long, when used to treat a tendinopathy?

The only issue I am aware of is the risk of frostbite.

E.g. http://www.active.com/running/articles/do-s-and-don-ts-for-icing-injuries:

Don't ice for more than 20 minutes or you'll risk frostbite. If your skin looks red, it's a warning sign you're pushing it. Remove the ice once you feel numbness.

Is there any other issue?

I am asking for three reasons:

  • curiosity
  • some ice patches tend to get pretty warm after 20 minutes, and doesn't seem to pose a risk of frosbites.
  • patients sometime exercise right before sleeping, and may fall asleep during icing. Empirically, it didn't create the frostbite, so I wonder if it's okay.


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