Heat or Ice?

One of the most common questions from patients is whether to use heat or ice treatment on a certain injury or symptom site. The answer lies in the acuteness of the injury, and therefore what the actual aim of treatment is. It is also important to clarify the exact technique involved.

Ice Treatment

When Should I Use Ice (Cryotherapy) On An Injury?

The use of ice/cold therapy on an injury is indicated within the first 72 hours following injury, this 72 hour mark encompassing the inflammatory phase of the injury/healing timeframe. Common injuries to respond to the immediate use of ice include ankle sprain and knee ligament injuries.

It is also recommended that cryotherapy also be used initially following any exacerbation or irritation of an injury. This may be the case when an individual is perhaps one to two weeks post injury (by which time heat treatment may be more appropriate), the happens to re-injure the same site again – again, as this will restart the inflammatory process, reverting to cryotherapy is again pertinent.

Also, ice treatment is appropriate for treating injuries which manifest as one of chronic inflammation, whereby the implicated muscle/ligament/fascia never progresses past the inflammatory phase. In this case, ice is always the treatment of choice. Such conditions include lateral epicondylitis (tennis elbow), plantar fasciitis, and carpal tunnel syndrome.

How Does Ice Treatment Help An Acute Injury?

The localised cooling effect of ice treatment serves to gain vasoconstriction (narrowing of the blood vessels). As inflammation and swelling are immediately brought to the injury site via the bloodstream, a restriction on the size of the blood vessels limits the amount of swelling that travels to, & accumulates, at the injury site. This measure serves to limit the restriction post injury, and also reduce the amount of pain experienced, as it is a particular chemical within inflammation that is responsible for causing acute pain.

Ice For Low Back Pain?

Low back pain is possibly the only injury for which ice treatment does not prove beneficial – regardless of length of time post-injury, heat is always the treatment of choice.

Precautions/Instructions For Using Ice

  1. A bag of cubed or crushed ice, or frozen vegetables are deemed to be the most appropriate tools for ice treatment – far more effective than any ice sprays etc.
  2. Do not apply ice to skin which is hypersensitive, and lacks sensation or circulation
  3. Be sure to wrap any ice in a thin towel etc., not applying directly to the skin. This prevents ice burn of the skin.
  4. Ice treatment can typically be safely used for 5-15 at a time. Regularly checking skin colour maintains safety, as treatment can be ceased once the skin has turned a pinkish colour.
  5. Once the affected area begins to lose feeling, treatment has been effective and can be ceased.
  6. Ice treatment should not be painful – remove the ice immediately if this becomes the case.
  7. The affected area can be iced regularly throughout the day, even as often as two-hourly

How To Enhance The Effectiveness Of Ice Treatment

Several measures can be undertaken alongside cryotherapy to maximise its effectiveness. The use of a compression bandage over the affected site can assist with the prevention of localised swelling. This bandage can be used for the duration of the day, but removed occasionally to allow the skin to breathe and any moisture to be removed from the area. Elevation of the affected limb – for example, a sprained ankle would be positioned above the height of the hip – enables gravity to assist in the drainage of swelling from the affected site back into the body, from where it is removed. Resting of the injured site is also important in minimizing the degree of inflammation, as aggravating use of the injured body part can simply induce the production of even more swelling.

 

Heat Therapy

When Should I Use Heat Therapy On An Injury?

The use of heat therapy on an injury is indicated from the fourth day onwards following injury, this timeframe representing the end of the inflammatory phase of injury & the beginning of the healing phase. Common injuries to respond well to the immediate use of heat from this time onwards include muscle strains and acute low back pain.

Heat treatment is also hugely beneficial in “warming up” a stiff or tight muscle/joint prior to exercise. Heat treatment is also recommended as a regular maintenance treatment for those who tend to sit for long periods (desk workers, drives etc.) – applying heat to a stiff lower back, neck etc. can go a long way to preventing this stiffness progressing to pain.

How Does Heat Treatment Help An Injury?

The localised heating effect of heat treatment serves to gain vasodialation (widening of the blood vessels). As oxygen and nutrients are brought to the healing tissue in the blood, an increase in the volume of blood getting  to the pain site will effectively increase the rate of healing. Increased circulation to the area will also enable more efficient removal of swelling and waste material produced in the healing process. Maintaining circulation will also prevent muscle or joint stiffness.

Precautions/Instructions For Using Ice

  1. A hot water bottle or microwaveable wheat heat pack are deemed to be the most appropriate tool for heat treatment, more effective than any heat sprays or microwaveable “hot & cold” packs.
  2. Do not apply heat to an area which is hypersensitive, and lacks sensation or circulation
  3. Be sure to wrap any heat source in a thin towel etc., not applying directly to the skin. This prevents  any possible burning of the skin.
  4. Heat treatment can typically be safely used for 5-15 at a time. Regularly checking skin colour maintains safety, as treatment can be ceased once the skin has turned red.
  5. Treatment should not be painful – remove the heat immediately if this becomes the case.
  6. The affected area can be heated regularly throughout the day, even as often as two-hourly

How To Enhance The Effectiveness Of Heat Treatment

Several measures can be undertaken alongside the use of heat treatment to maximise its effectiveness. Maintaining mobility of the affected area will serve to maintain joint and muscle mobility/flexibility, and maintain circulation. This can generally be achieved by taking a short walk or changing position half hourly.