Most Frequently Asked Question: Ice Or Heat?

By Roy A. Majors, M.D.
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(Photo by Julian Finney/Getty Images)

(Photo by Julian Finney/Getty Images)

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PROBABLY THE MOST FREQUENTLY ASKED question regarding sports injuries is, “When do I use ice and when do I use heat, and with which injuries do I use which?” It is fair to say that most people will use ice following their initial injury and after a few days begin to use heat to treat the injury. This is a fairly safe approach to take. However, by understanding the very basics of ice and heat treatments, one will be less likely to actually aggravating the injury.

With either minor or major muscle strains or ligament sprains, an actual tissue injury occurs. This injury is in the form of torn tissue with secondary bleeding and inflammation. By using ice during the first 24 to 48 hours, the small blood vessels will constrict, reducing the amount of both bleeding and inflammation, resulting in an improvement in pain. Sometimes the inflammation and swelling can last way beyond 48 hours or can be periodically aggravated by normal activities of daily living which might require extended periods of icing. The best rule of thumb to go by is if the injured extremity is beginning to swell and throb, then ice is appropriate treatment. This will most often occur after resuming activities. The need for episodes of icing may last several days to a week, depending on the severity of the injury.

Ice therapy usually needs to last a minimum of 20 minutes to provide good cooling which will promote decreased swelling. Ice can remain on
an extremity for hours as long as the patient is careful to assure the skin is not frozen, which
could cause blistering.

Heat therapy is used to increase circulation to and within muscle tissue, as well as decrease the viscosity of the fluids around tendons and ligaments and within joints which decreases stiffness. This helps to promote better range of motion which will decrease the risk of injury to tendons and ligaments when they are stressed. This is analogous to a good warm-up program prior to any activity. Therefore, heat is best used prior to any rehabilitation of an injured extremity which will allow one to more fully rehab the extremity with decreased risk of reinjury.

Heating of an extremity takes 10 to 15 minutes or longer, depending on the mode of heat application. Similar to ice therapy, one must
take caution in preventing any thermal injury to the skin.

To summarize, major and minor muscle strains and ligament sprains are best treated with ice therapy indefinitely until the extremity
has recovered. Ice should be used after any physical therapy or rehabilitation in order to decrease secondary swelling and inflammation. Heat is most appropriately used prior to any rehabilitation or return to activities in order to decrease the risk of re-injury.

The final note is the use of heat and ice contrast. This is when heat and ice are alternated in 10 to 20 minute intervals following rehabilitation of an injured extremity or following activities. This technique is felt to better facilitate the healing and recovery potential of an injured extremity after its physical rehabilitation. One must keep in mind if they are going to use heat and ice contrast therapy, they should always end their program with a minimum of 20 minutes of icing. This will help minimize the amount of recurrent swelling, inflammation and pain.

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