When to use Ice or Heat for an injury

This is a subject that I probably talk about nearly every day because of the type of work that I do: treating injuries. It seems that a fair amount of people tend to neglect using one or the other and when they do make an attempt at using ice or heat, it is sometimes used at the wrong times.

So what is the correct way to utilize heat or ice? The best answer is that it depends on the circumstances, such as the type of injury, the individual involved and the duration of the injury. Each injury and each person has their own uniqueness about them so it is sometimes difficult to figure out which is most effective.

Let's start with types of injuries:  

Acute- These are sudden type injuries like a broken bone or sprained ankle where there will be significant swelling and inflammation involved. Acute injuries can last anywhere from 72 hours to 2 weeks. It is during this time, that ice is preferred and necessary. It is necessary to reduce any swelling and to numb the area, which will in turn reduce pain. Adding heat during this time should be avoided because it may actually increase swelling and pressure to the area which could result in increased discomfort.

Chronic- These type of injuries have developed over a course of time and are usually due to older accidents or an overuse syndrome (heavy lifting at work, computer work causing carpal tunnel, etc.). For the most part, heat is indicated for this type of injury unless it is a new aggravation of an older injury and there is swelling and tenderness involved. At this point, ice may be your best option.

Types of Heat and Ice and length of use

Heat: 

There was a time that the good ol' electric heating pad was the preferred choice but we have come a long way since then. While the electric pad is okay, it will distribute dry heat and the most effective source of heat is moist heat. Why? Because moisture will allow the heat to dissipate deeper into the muscles and tissues. If you have an electrical dry pad, you can apply a moist towel to the affected area and then place the pad over the towel ( I have given that recommendation out countless times over the years and no one has been injured....yet!)

A word of caution with electrical heating pads: don't use them in bed. Very easy to fall asleep and the small chance of a malfunction leading to serious injury. 

Other great sources of moist heat include: hot showers or baths, jacuzzi or hot tub, saunas or hot springs.

The general rule of thumb for heat usage is approximately 20 minutes. Anything more is basically useless and can also cause  decreased circulation to the area if used more than the allotted time.

Ice:

This is as easy as it gets. No real reason to go out and spend money when you can just wrap some ice in a towel or ziploc baggie and apply it to the area. Frozen bags of food can also be a temporary remedy. There are some great large and small ice packs to purchase if you did want to spend a little money. 

Another cute option is an ice massage. All you are doing here is filling up a paper cup with water, freezing it, peeling back the rim and massaging the area with the exposed ice.

The length of time to use ice is very important. Basically, you do not want to ice an area for more than 20 minutes at a time. My recommendation is to ice for 20 minutes, remove for another 20 minutes and then re-apply the ice for 20 minutes. Repeat this cycle for 2 hours.

The goal of ice is to numb the area to decrease the pain. At first you will probably feel, well, cold. Followed by burning, aching and finally numbness. At this point, the ice becomes ineffective.

What are some contraindications for Ice/heat (When not to use Ice or heat)

ICE

-decreased or increased sensation

-circulatory conditions

-Raynaud's disease

-High blood pressure

-frostbite

HEAT

 - Inflammation/swelling

 - infections

 - heart conditions

 - metallic implants

Hopefully, this has shed some light on the much debated question of ice or heat. You might get a different opinion from many different people or doctors or people trying to act like doctors but either way when dealing with most types of pain, the application of ice or heat is critical for the healing process.