ICE
OR
HEAT?
Should you ice or heat an injury?
This is a question that often arises. In
certain circumstances there is a definite
answer but in other cases it is more down
to personal choice. The application of ice
(cryotherapy) or heat is often linked to how
old the injury is and the stage of healing.
Ice for new, acute inju-
ries
(up to 72 hours)
These injuries are usually
characterised by a body part
that feels hot (usually a joint
or muscle) when compared
to the uninjured side. It can
be swollen, painful and red-
dened. These are the symp-
toms of inflammation and
ICE is always indicated. The
application of ice minimises
the extent of damage and
inflammation to assist a faster
recovery. It is often advised
that an acute injury follows
the PRICE regimen :
Protect:
Use aids and
appliances to minimise the
stresses on the injured area.
For example with an ankle
sprain a pair of crutches
would be useful or with a
shoulder injury a sling will
support the injured part.
Rest:
Try and avoid pro-
voking the injured area and
causing further trauma and
inflammation.
Ice:
This can be applied in
a number of ways from com-
mercial ice bags or more
commonly using something
like bag of frozen peas. It
is important that you avoid
ice burn by ensuring there
is a barrier between the ice
bag and the skin – the usual
recommendation is to wrap
the ice bag in a wet tea towel.
Whilst some debate exists
over how long the ice bag
should be placed on the
injured part and how many
times a day, the common
advice is often that it should
be applied no longer than 15
minutes (less debateable) for
4 times a day (far more de-
bateable!).
Compression:
Apply
compression at the earliest
opportunity following injury
to limit and reduce swelling.
This is most often the case for
a joint sprain or muscle strain.
Compression bandages,
elasticated tubular bandages
or orthopaedic supports are
common means of achieving
this. Ensure that the com-
pression is even across the
injured part, and regularly
check the extremities (fingers
and toes) for diminished cir-
culation ; cold, blue, altered
sensation or swollen - these
are common signs of too
much compression. It is rec-
ommended that you remove
compression whilst asleep.
Elevation :
Try and el-
evate the injured part at the
earliest opportunity. This is
to help reduce swelling and
is therefore most effective
for oedema (swelling) that
occurs at the extremities of
the body such as an ankle
sprain.
Heat for chronic
Injuries (2 weeks +)
There is much debate about
the definition of chronic. Some
describe it in terms of time
frames, others more in terms
of the stage of healing. For
the purpose of this information
page it doesn’t really mat-
ter. A chronic injury is usually
characterised by stagnation in
terms of healing. The injured
part will usually feel the same
temperature as the non injured
side, sometimes it may be
accompanied by slight swell-
ing if it is a joint of the lower
limb. There is a strong sense
that the body has finished its
healing process but left some
residual deficits that continue
to cause a problem. This pla-
teau in recovery is most often
treated with HEAT.
Heat over the injured part will
increase the blood flow to it
and therefore stimulate activ-
ity around this area. If it is a
swollen joint this may help
reduce any swelling and help
flush out any inflammatory
agents around the injured site.
The provision of a increased
blood supply with greater
oxygen and nutrients can help
speed up the healing process
and decrease pain. If it is an
injured muscle then heat can
reduce muscle spasm (or
tone) - compare and contrast
the difference in muscle tone
when we are faced with the
cold (shivering) against how
our muscles relax in the heat
(picture melting away on your
sun lounger !). A decrease in
muscle spasm will decrease
pain and help you to move
more normally.
Application of heat
Heat modalities come in
many forms. Commonly a
clinician may recommend
a heat bag that can be
placed in a microwave, a
hot water bottle, commer-
cial heat packs/pads or
hot baths. A comfortable
warmth is desirable and
usually the application of
heat is for a period of 20-30
minutes.
Exceptions, debates
and personal choice to
Ice or Heat
Ice treatments might also
be used for chronic con-
ditions, such as overuse
injuries in athletes – com-
mon conditions where this
is the case is when a ten-
don repeatedly becomes
inflammed over a long
period of time. This can
be described as ‘an acute
on chronic injury’. In this
case your clinician may
advise you to apply ice im-
mediately after the activity
to minimise the degree of
swelling. For an overuse
injury the clinician may also
recommend heat before the
activity to relax and loosen
tissues.
If there is chronic swelling
of a joint such as a long
standing ankle problem
there would be a reason-
able
argument for a clinician to
recommend BOTH heat
and ice. We have men-
tioned that heat increases
blood flow (vasodilator) and
ice decreases blood flow
(vasoconstrictor). With chronic
swelling there is a theory that
a pumping action can be
achieved by placing the heat
on the injured area for 5-10
minutes and then applying the
ice for the same period of time.
This cycle is often repeated
for up to 30 minutes. When
hot and cold water is used to
achieve this effect it is known
as a contrast bath.
Where pain is the primary
problem with a chronic injury
(such as low back pain), the
choice of using ice or heat can
be a personal preference. On
one hand ice has the effect of
distracting away from the pain
whilst heat can help relax the
muscles around the painful
area.
Conclusion
Ice is the treatment of
choice for hot, inflamed,
acute injuries. It helps
reduce blood flow and
lessen the extent of
damage. Heat should
never be used on acute
injuries.
Heat is the treatment of
choice for most chronic
injuries. It helps increase
blood flow and can reinvig-
orate the healing process
of a stagnant condition.
There can be further
complexity of when to use
ice or heat and, as ever,
this decision is best
determined by a qualified
practitioner.
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