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 Ice or heat?

One of the most common questions I get asked when treating people with injuries is, “Should I use ice or heat?” Well, both hot and cold treatments are effective ways of reducing pain, promoting healing, and preparing you for your activity. However, if not used at the right time or in the right way, it can actually delay your recovery or make an injury worse.

The best time to use ice is during the first 24-48 hours after an injury such as a strain, sprain, or bruising. Ice helps to reduce pain, decrease swelling, and prevents further injury. Heat should not be used during this time because it will increase blood flow to the area when bleeding and swelling needs to be controlled. Ice can also be used to treat repetitive strain injuries like tendonitis, or to decrease muscle spasms.

There are many ways to apply ice including cold gel packs, crushed or cubed ice, cold cloths, or even a bag of frozen vegetables. Right after an injury it is good to combine the use of ice with compression and elevation to further minimize swelling. Ice may be applied for 15 to 20 minutes at a time and used again every hour. It is important to wrap the ice pack with a damp towel to increase transfer of cold and to prevent frostbite.

Another helpful tip is to keep paper cups with water in the freezer for an ice massage. Peel away the rim and start rubbing the ice in small circles over the injury for about 7-10 minutes.

It is normal for the area to feel cold at first, then it may burn, then ache, then finally become numb. Avoid using ice longer than the recommend time because it can lead to nerve or tissue damage. Generally speaking, ice should not be used as treatment for people with decreased sensation, poor circulation, high sensitivity to cold or on open wounds.

After the first 48-72 hours when swelling has stopped and skin is no longer hot to the touch, you can start using heat. Heat promotes healing and removal of waste by increasing blood flow, which carries oxygen and nutrients to the area. It can be used to relieve pain, relax tight muscles, reduce joint stiffness, and allow for a wider range of motion.

Heat can be applied by using electric heating pads, hot water bottles, hot packs or “Magic Bags” and moist heat. When preparing a hot pack, first wrap it with a damp towel and then cover it with a dry towel before applying it to the skin. Layers of towels should always be used to protect the skin from irritations or burns. Hot packs do not need to be applied longer than 10-30 minutes to achieve the desired effect.

Check the skin frequently and remove the heat if you experience abnormal changes in skin colour or more pain. Never leave lie on a hot pack for long periods of time or apply heat while sleeping because it puts you at risk for burns. Lastly, avoid using heat as treatment for people with decreased sensation, problems with circulation, areas of bruising or on open wounds.

The type of injury and when it occurred – and your preferences – should all be considered when choosing to use ice or heat. If you are unsure about your specific injury or condition, talk to your physiotherapist or health care professional for advice on the proper management.

Source: Canadian Physiotherapy Association

Adrian Salonga is a graduate of the University of Manitoba with a Bachelor’s degree of Medical Rehabilitation in Physical Therapy.

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