That Famous Question – Heat or Ice…?

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Heat or Ice Application Post-Injury?

One of the most common questions we receive from our patients is whether to use heat or ice treatment on a certain injury or symptom site. The lack of clarity on this matter is understandable, due to a multitude of contradictory online information, conflicting advice from friends or family, or simply inconsistent responses when we do use these treatments at home ourselves. 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.

As a general guide, we recommend the use of ice/cold therapy on an injury within the first 72 hours following injury, this 72 hour mark encompassing the inflammatory phase of the injury/healing time frame. Basically, within this time period, the body’s natural response to injury – the production of considerable amounts of protective swelling which is directed to the injury site – takes place. While necessary and helpful, this inflammatory process is often “overcooked” and provides an excessive restriction to daily function, while also prolonging the return to normal activities. To control this effect, 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.

It is also recommended that ice therapy 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 would be indicated), the happens to re-injure the same site again, as this will restart the inflammatory process, reverting to ice therapy 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. Essentially, in this case, even though the injury may be longstanding, it still demands to be treated like a new, acute injury.

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, generally to prevent stiffening of the lumbar spine.

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

Several measures can be undertaken alongside ice therapy 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.

The use of heat therapy, on the other hand, is generally indicated from the fourth day onward post injury, this time frame representing the end of the inflammatory phase (day 0-3) of injury & the beginning of the healing phase. Common injuries to respond well to the use of heat from this time onward include muscle strains and acute low back pain. 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

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.

 

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.

Liam