When to use Ice and when to use Heat for an injury has been a question people have asked me for over 20 years. There is no single best answer and the answer depends on several factors.

First lets see what affect these 2 agents have on the body:

• Ice: constricts (makes smaller) blood vessels, eases pain by slowing nerve conduction speed, promotes muscle relaxation and slows the metabolic rate. Ice is applied via ice packs, ice massage, cold towels or ice baths. Ice is usually applied for 10 to 20 minutes. Ice is generally applied immediately following an injury to reduce pain and swelling/bruising.
• Heat: dilates (makes bigger) blood vessels, promotes healing by increasing nutrient flow and promotes muscle relaxation thus reducing pain. Heat is generally applied after the pain, swelling and disability of an injury has begun to subside. Heat can be applied in the form of moist heat packs, warm moist towels, hot baths or plug in heating pads. Heat can be applied for 15 to 30 minutes.

   

When you have an injury, such as an ankle sprain, the body begins a very complex self-healing process.

• Pain is caused by direct damage to tissue, muscles, joints, tendons or bones. This pain is caused by a chemical reaction that irritates nerve endings. Pain is a natural body response and it tells us not to use or move the injured part, thus protecting it.
• Swelling is caused by a collection of blood and other damaged tissue cells. Swelling will further cause pain by putting pressure on surrounding tissue and nerves. Swelling helps immobilize the area, tightening the involved joints, thus limiting motion and protecting it.
• Loss of function or use of the injured area is caused by both pain and swelling. This causes the individual to not use the injured area, thus allowing the body to begin its normal healing process.

Initially after an injury, apply ice to control pain and swelling. Ice should be applied for the first 3-5 days, 2-3 times per day. Elevate the injured area to reduce swelling as well. Never put ice directly on the skin as this could cause frostbite. A dry or slightly damp towel will protect the area. Ice should be applied until you notice a decrease in pain, decrease in swelling and in increase in functional use of the injured area. This indicates that healing is occurring. Heat can then be applied to assist in the healing process. Heat should be applied before the area is stretched or exercised. Do not fall asleep on a heating pad as this could cause a severe burn. Heat the area for 15-20 minutes 2-3 times per day. Ice can still be applied if increased activity has caused an increase in pain or swelling.

In general, ice should be applied to control pain and heat should be applied to aid in the healing process. If you have any doubt on which you should use for your injury, consult with your physician or a physical therapist.

 Terry Robinson PT, ATC

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