Ice or Heat?
We are frequently asked whether you should apply ice or heat to an injury. Should you ice first? Should you apply heat first? How long should you use it? Maybe you should alternate between the two? How long should you leave it on? Ice Knee Heat Knee…or Nothing?
While modern physical therapists called these modalities, the application of cold and heat goes back as far as anyone can remember. In order to understand which one should be applied when, it’s important to understand what the underlying mechanism of injury is and how the body reacts to it.
Strains and sprains are microscopic (and sometimes not so microscopic) injury to muscle, tendon and ligament. Once the tissue is disrupted, the small blood vessels that feed the area are also disrupted resulting in leakage of blood into the injured tissue. The body has several mechanisms for eventually stopping this bleeding. So why don’t these kick in immediately? When there is an injury, it is important to get as many healing factors in the area so the body can start it’s repair process. While it is a good thing, it can cause increased pain and decreased range of motion and can become excessive. By adding ice initially with the injury you can control the amount of swelling to minimize the amount of pain and discomfort that you are feeling. Maximum swelling will usually be achieved within 48 hours of the initial injury. Thus, it is important to use ice for the first 48 hours.
After the initial swelling is controlled, it’s time to get on with the process of healing. In this instance, increasing the amount of blood flow, and the number of healing cells, to the area is important. You can help that process by the application of heat which increases the blood flow to the surrounding tissues and gives your body in optimum environment to try to heal. Increased he also loosens the muscles and allows them improved range of motion during the healing process.
When applying either ice or heat, it’s important to do it safely and not overdo it. Healthcare practitioners have seen people who developed frostbite from leaving ice on too long and significant burns from too much heat. A good rule of thumb for ice is to wrap the ice in a towel and then apply it to the affected area for no more than 15 minutes at a time. Also remember to elevate the area of injury because gravity tends to pull fluid downward. When applying heat, remember that hotter is not better. Low heat that radiates overtime will have a better effect and less risk of burning your skin.
Lastly, if you have any injury that requires prolonged use of ice or heat, you should seek the advice of the healthcare professional. The doctors at Sports and Orthopedic Center are experts in the evaluation, treatment and rehabilitation of injured tissues.