Chill Out or Heat it Up? – Ice or Heat - October 5th, 2010

With a background in sports medicine, I am often the first person my family calls when an injury occurs.  Usually the call begins with “I did ________ and it hurts.  Do I apply ice to it or do I put a heat pad on it, I can never remember?”    But the previous question is one of the most commonly asked questions in the sports medicine world.   It can be confusing because both ice and heat can help your body’s healing response.   Ice restricts blood flow which will help reduce pain and inflammation to the injured site.  Heat increases your bodies circulation which helps your body bring more oxygen to the injured area, thus encouraging healing and removing waste products from the area.   Even though ice and heat can both aid in healing, using the wrong one, at the wrong time and for the wrong amount of time could delay your body’s healing response.

Below is a simple explanation to help you know when to use ice, heat, or both.

When to use ICE:

Apply within the first 24-48 hours after injury.  The sooner the better (withing 20 minutes of injury to prevent swelling).  Using a bag of crushed ice (or frozen veggies), apply to injured area with a moist towel in-between the bag and your skin.   Apply for 20 minutes and then remove until the skin temperature returns to normal (about 40 minutes), then you can apply again.  Repeat often.   Continue until there is no more inflammation, pain or swelling.  NOTE:  If you have Raynaud’s disease or you have a former frostbite injury, DO NOT apply ice to the affected area.  Also, if you have any circulation issues or nerve injury, consult your doctor before applying ice.

When to use HEAT:

You can apply heat 24 hours AFTER a minor injury (light strain, etc) or 48 hours AFTER an acute injury (sprained ankle, pulled back muscle).   Place heat back on the injured area for about 20 minutes.  Do not apply body weight on the heat pack (i.e. sit on it or lie down on it).   DO NOT apply heat to an area that has broken skin.  Using heat should not be painful.

When to combine both ICE and HEAT:

Use a combination of ice and heat about 48 hours AFTER an injury. Either alternate cold and hot packs for 10 minutes, or try a contrast bath. Fill two buckets, one with cold water and some ice (this will feel very cold on your toes), and the other with tolerably hot water. Soak the area in the cold bucket for 2 minutes, then switch to the hot bucket for 2 minutes. By alternating, you keep the swelling down with the cold, while you keep the blood and its nutrients circulating through the injured area with the heat.   This is a commonly used method is sports medicine rooms.

To sum it up…the best thing to use right after an injury is ICE.  You can also read my article about R.I.C.E. which is the best way to manage an acute injury.  If you have more questions, ask your doctor! 🙂

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