There seems to be a lot of confusion about which therapy to use following an injury… heat or ice? Most people know to use ice immediately following a sports injury, but when is it appropriate to use heat? Heat is arguably much more comfortable than a frosty cold pack, but there are advantages to both that are very important to your recovery regardless of comfort. The following is a simple guideline for the use of heat and ice therapy.
The first thing to understand is that there are two basic types of injuries/pain: acute pain and chronic pain. Acute pain arises rapidly and is usually short-lived in nature (i.e. ankle sprains). Acute injuries occur immediately and are often the result of some sort of trauma which result in pain (possibly severe pain). Acute injuries often occur as a result of a fall, collision, or some other form of trauma. Acute injuries have some common signs and symptoms including pain, tenderness, swelling, redness, and the skin is often warm to the touch.
Chronic pain develops slowly and is long-lasting (i.e. arthritic knee). These injuries are much more subtle than acute injuries and may often be sporadic in nature. Many times these injuries are caused by overuse, such as wrist injuries with prolonged typing at work. These injuries can stem from acute injuries that are not treated properly, which leads to the development of a chronic condition. Some common signs of chronic injuries include prolonged soreness, tenderness, no swelling, no inflammation, and decreased range of motion.
In general, ice therapy should be used for acute injuries or injuries which take place within 48-72 hours. Cold therapy is best for these types of injuries because the cooling effect of ice constricts the blood vessels and limits bleeding and inflammation to the injured tissue. Ice is effective in decreasing swelling and inflammation and should be used directly after an injury.
On the other hand, heat therapy, such as a hot pack, can be used for injuries which do not have inflammation with associated swelling. Heat dilates or opens the blood vessels and allows increased blood flow to the area, which is good for relaxation of muscles. On the other hand, if heat is used for swollen muscles or joints, increased inflammation can actually increase inflammation. Heat is an excellent therapy for sore muscles and joints which have been painful for longer than 48-72 hours. Heat therapy can also be used prior to exercise/activity in those with a chronic injury to loosen muscles and joints.
General Take-Home Messages Heat/Ice Application:
Only use ice directly following an injury for the first 48-72 hours.
Only use heat for injuries which have been present for more than 48-72 hours.
After activity, only use ice (even if chronic-type pain).
If using contrast therapy (i.e. ice 10 min., heat 10 min, ice 10 min., etc.), always finish with ice.
When in doubt, use ice (except prior to activity).
Never leave heat or ice on an injured area for more than 20 minutes at a time.
Do not fall asleep with a heat or ice pack on!!
How to make a heat pack at home:
Moist heat is best, so boil a towel or microwave a wet towel (30-60 seconds) or use a store-bought heat pack and apply for no more than 20 minutes. If skin becomes too hot or irritated, remove hot pack and let cool before applying again.
How to make an ice pack at home:
Place ice in a Ziploc bag with a little bit of water and cover bag with a paper towel, apply to affected area. You can also use an ice cube to massage the injured area. There are many excellent form-fitting ice packs available on the market as well for convenient use.
*If ice is applied to an injury for 48 hours with no improvement, consult Green Health Acupuncture or your physician.
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