1. You can never go wrong with ice.
2. Always ice for the first 72 hours.
3. If you use heat and within a half hour to an hour you feel stiffer and more sore then you should be icing.
4. Use moist heat over dry heat.
5. Use a wet towel between the heat/ice and your skin.
Have you ever been in a situation where you sprained your ankle or your shoulders are feeling tight and you have no idea whether you should use ice or heat? I get asked about this often. This is what I tell my patients; with a little extra detail.
First and foremost, ice is your best friend. You can’t go wrong with ice. In every typical condition ice will not harm you. Ice decreases the inflammatory process which causes swelling. If there is less swelling there will be less impairment after the inflammation has stopped. Ice also decreases the sensation of pain. If there is no pain then the muscles that are in spasm and protecting the body are allowed to relax.
I recommend icing when there is:
1. Less than 72 hours after injury, for example, after an ankle sprain.
2. A chronic injury that has recently become more aggravated.
3. Warmth and swelling of the area.
For small areas take an ice cube and massage it for 7 minutes or until it is numb. For moderately sized areas, use a therapeutic ice pack or a bag of frozen peas so it can wrap around the area. Don’t apply directly to the skin. A wet towel should be between the body and the ice. For larger areas, such as a leg or arm, use an ice bath. The temperature of the bath should be between 12 and 15 degrees Celsius.
Ice should be applied for 10 – 20 minutes depending on the thickness of the area. The thicker the area the more time is needed but do need exceed 20 minutes. Icing should be performed every two hours and not just once or twice.
When icing you should expect to first experience cold followed by burning, then achy and finally numbness.
Ice should not be used if you have:
1. Raynaud’s Disease
2. Rheumatoid Arthritis
3. Cold Hypersensitivity
4. Cold Allergy
5. Diabetes with vascular disease
6. Peripheral vascular disease.
8. Impaired sensation
9. Icing the front of the neck
11. Paroxysmal cold hemoglobinuria
12. Elderly with fragile skin
Recently, there has been less emphasis of ice during acute injuries. The reason behind this is that we want inflammation so that the healing process can occur. Ice may result in little to no inflammation which may not be sufficient for healing. There is now a strong emphasis on using compression to limit the volume of swelling in the injured area.
Heat should NEVER be used immediately after an injury.
I recommend heat when:
1. There are tight muscles.
2. The condition is chronic.
3. When the injury is no longer inflamed or warm to the touch.
Heat increases blood flow to an area which brings all of the vital nutrients it needs for injury repair. In addition, it has a calming effect to relax muscles thus allowing them to be more flexible and allowing you to have increased mobility. Heat will also help to reduce pain as well as muscle spasm.
I recommend using moist heat to my patients. This can be done by soaking the area in a hot bath or heating up a wet towel until it is comfortably hot. Moist heat penetrates deep beyond the skin. I am not a proponent of using the products that you heat up in the microwave or heating pads because these are considered dry heat which only treats superficially and does not reach the muscles that need it. Heating should be performed for 15 to 20 minutes. Check the skin every once in awhile to ensure that the skin is not burning.
Heat should not be used if:
2. impaired sensation
4. Impaired blood flow
5. multiple sclerosis
7. deep vein thrombosis
The Grey Area
The grey area is that time where the patient is beyond 36 hours after the injury. This is a time where we are not completely sure whether heat or cold is required. This is a typical situation. The patient uses heat and they will feel good immediately after using it but then within a half hour or hour they experience feeling more stiff and tight. This is likely an indication that there is still an inflammatory process occurring therefore the patient should use ice.
1. Klein, MJ Superficial Heat and Cold. Available at:http://emedicine.medscape.com/article/324974-overview. Accessed February 9, 2009.