When do you use Ice or Heat for injuries?

This controversy has been around a long time in the public sector as well as the medical community. This article has hopes of putting this to bed. Ice versus heat for sprains and strains of musculo-skeletal issues have been bantered about with individuals hanging onto there methods unwilling to budge. Evidenced based medicine is literally that, medicine founded by research that has a statistically significant outcome. Many organizations rely on these studies for they do create the “standard of care.” The standard of care is what is best for the patient. Patients come to providers for just that reason, what is the best and most effective treatment. It is up to us, the clinicians to implement the treatment. This author has researched this topic and pulled information from the American Orthopedic Society for spots Medicine, and the American Academy of Family Practice. All evidenced base research.

How does Ice and Heat work on the body?

Let us first look at the mechanism by which ice and heat work. Ice constricts blood vessels and reduces swelling. I will not go into intracellular fluid and extracellular fluid.however swelling is from blood and lymph. This is the most common when we sprain an ankle. Ice reduces both of these mechanisms by slowing that process down as well as elevation. Gravity in this situation is bad. Elevate the injured extremity.

Heat is used after the swelling decreases and is usually left for injuries after the first 72 hours. It makes no sense to use ice when the swelling is decreased. Heat, specifically wet heat helps dilate the blood flow. When you dilate blood flow you increase circulation to the muscle tissue. Is it any wonder that all your professional athletic trainers have a hot whirlpool in the training room. If you really want to know what to use look at your professional athletes. When money is on the line, a few million I do not see them steering them down an unhealthy road. They have to get that athlete back on the field. Heat is great for chronic injuries.

How and When do you use ice and heat for injuries?

Use ice for acute injuries. Never apply the ice directly on the skin. Ideally fifteen to twenty minutes. I am sure my audience has used ice and you know how painful it can be. You do not have to torture you child when they sprain their ankle. In fact many studies show NO significant change when there is no ice applied. Studies show maybe a day difference in recovery and this depends on the severity of the sprain and the age of the child. Massage the ice over the area. The main reason for this is to avoid pain from the ice as well as frostbite. Yes, I have seen very compliant patients who are very motivated to get back on the field leave ice on for a long period of time and experience a burn to their skin.

Heat is great before activities such as running, jogging and even some sport events. Some professional pitchers will use heat before they go out and pitch to loosen up the muscle tissue. It is also good for chronic injuries. Chronic injuries are any injury lasting longer than six months. Ice though is used for the pitcher coming off the mound to decrease swelling of the rotator cuff and shoulder area. Never apply heat while in bed, too frequently individuals fall asleep with a heating pad on high. I have actually treated burns secondary to leaving the heating pad on too long.

In summation, ice for the first 24 to 48 hours for acute injuries. Then wet warmth. Heat a cloth in hot water and leave it on till it cools. Ice for swelling and reduce tissue injury. Ice has not been proven to expedite healing after the first two days. Remember the way we learned it is not the way it is now, we change, medicine changes and life keeps changing.

-American Orthopedic Society for Sports Medicine Chris Bleakley, et.al. American Journal of Sports Medicien 2004 vo.12

American Academy of Family Practice.