When to use heat or ice to treat an injury
Clinical wisdom is thus a matter of research as available, intuition, experience, and consensus.
Cryotherapy = the application of cold for the treatment of injury or disease.
Thermotherapy = the application of heat for the treatment of injury or disease.
The benefits of cryotherapy includes:
- reduction of pain due to numbing affects on local nerves.
- reduction of spasm due to reduction of local blood flow and nerve sensitivity.
- metabolic stabilization of acute injuries reducing the recovery time.
- decrease the inflammatory - pain/redness/swelling/heat - response to injury.
- rehabilitative treatment of chronic injuries.
- reduce pain effectively in the post-operative period after reconstructive surgery of the joints.
**** Using a cold compress can also reduce the pain, swelling, and inflammation associated with gout and rheumatoid arthritis. A gentle approach is recommended. *****
Generally speaking, the newer and more severe the injury, and the more pain and swelling associated with the injury, the more you would use ice. The sooner ice can be applied, the better the overall results in terms of stabilizing the injury and promoting recovery.
For a new injury remember RICE: Rest, Ice, Compression, and Elevation *1
The importance of rest and accompanying elevation of the limb cannot be ignored *1. Elevation serves to rest the injured area, and utilizes gravity to drain excessive blood from the swollen area.
Various methods such as ice packs, ice towels, ice massage, gel packs, refrigerant sprays and inflatable splints can be used each with their own pros/cons.
- For home use an ice pack, frozen wet towel, or bag of frozen peas is inexpensive and convenient.
- Crushed ice, or ice cubes with a small quantity of water, contained in a plastic bag is often most handy and is less likely to cause frostbite in healthy adults.
- Ice massage cools the muscle faster than an ice pack. Try freezing water in a paper cup, peel away the top layer of paper and massage/rub the ice directly onto the skin over the injury. Use a towel to catch the drips.
- The most effective cooling method is bathing the affected area in a whirlpool ice bath. Elite/pro athletes often have to endure this treatment... imagine if it is a groin injury.
- In winter climates.... a bag of snow is convenient, cheap, and works well.
to 4 cm. I recommend applying the ice on/off for 10-20 minute intervals. Use shorter intervals for smaller joints and injuries with less insulation of skin fat. For larger and deeper areas use the ice longer. If the skin becomes firm or pressing your finger into the skin leaves a lingering pale spot, give the area a rest or warm with your hand for a few minutes to avoid frost-bite. The tissue below the skin will remain effectively chilled for up to 20 minutes.
To my understanding, the use of "ice gels" such as Deep Ice and Deep Cold may be cooling to the skin and soothe the pain of an acute injury, but I have not seen any evidence that they effectively cool an injury below the skin level. At best they are a comfort due to the counter irritation of the skin , but not an effective treatment.
For new injuries continue applying ice for the first two to three days. Traditional wisdom recommends that beginning about two days after the injury, one would begin alternating applications of heat then ice... always finishing with ice.
Nadler reports that contrast therapy (alternating between hot and cold treatment) provides no additional therapeutic benefits compared with cryotherapy or thermotherapy alone *2. It seems that alternating from heat to ice for short periods just keeps the internal tissue temperature near normal. Perhaps applying heat for 20 minutes, rest 20 minutes, ice 20 minutes, rest 20 minutes ...repeat... may have a net therapeutic effect of drawing fresh blood into the injury and promoting increase metabolism to stimulate healing, then using ice to prevent excessive swelling and inflammation. Opportunity for some research! Nonetheless.... As you continue into the rehabilitation stage of the injury, use elevation and ice after exercise for as long as pain and swelling persist.
Cold appears to be effective and harmless and few complications or side-effects after the use of cold therapy are reported. However, prolonged application at very low temperatures should, however, be avoided as this may cause serious side-effects, such as frost-bite and nerve injuries.
The conventional wisdom is to use heat to soothe an older injury. This largely due to the reduction in muscle spasm due to increased blood flow, and reduced pain sensation largely due to the stimulation of superficial nerves rather than physiologic effects in the deeper tissue. Using heat may stimulate healing and repair of new and old injuries in combination with active exercise and tools such as ultrasound and shock-wave therapy.
Heat can be applied in numerous ways from convenient gel packs to hot water bottles to heat baths to electrically insulated heating pads. Using a moist towel between the heat source and your skin can help the heat penetrate the tissue.
- A bucket of water heated to tolerance can be used to treat an ankle or elbow....but do be careful not to scald yourself!!! Immersing the entire body in a hot bath or shower can be soothing yet is unlikely to have much therapeutic effect on tissues below the skin level without dangerously raising the core body temperature. Use a moist heat compress instead.
- A heating lineament may be soothing and if it brings you comfort... why not? But what heat they do provide is due to increase blood flow to the skin (hyperemia) and they do not heat below the skin level. Do not use a heating lineament and then a heating pad as the combination can cause chemical/toxic burns to the skin.
- Do not use an electric heating pad If you are prone to falling asleep. Electric heating pads can stay warm and literally cook the skin, perhaps to a centimeter or so depth.
*3 Upon reviewing the literature much of the confusion arises from the limiting nature of studying heat and ice on injuries... how does one ethically and practically use sham heat or ice? Another limit is that many studies have very specific research parameters that do not necessarily translate to clinical use.
Nevertheless.... apply heat or ice with caution and some good sense. If you are unsure consult with your health professional.
Dr. Wayne Coghlan: Chiropractor.
Scott F. Nadler, DO, FACSM, Kurt Weingand, PhD, DVM, and Roger J. Kruse, MD, Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician Vol. 7, No. 3, 2004. 395-399.
Swenson, C., Swärd, L. and Karlsson, J. (1996), Cryotherapy in sports medicine. Scandinavian Journal of Medicine & Science in Sports, 6: 193–200. doi: 10.1111/j.1600-0838.1996.tb00090.x