Have you ever been in a situation where you sprained your ankle or your back is feeling tight and you have no idea whether you should use ice or heat?  This is what I tell my clients; with a little extra detail.

When to Ice

It is worth remembering that ice is your best friend. You can’t go wrong with ice. It will not harm you so long as you do not apply it directly to your skin. Ice decreases the inflammatory process which causes swelling. If there is less swelling there will be less impairment after the inflammation has stopped. Ice also decreases the sensation of pain. If there is no pain then the muscles that are in spasm and protecting the body are allowed to relax. When you remove the ice the natural return of blood flow to the area will bring fresh blood which is nutrient and oxygen rich, ready to start repairing the injury or muscle spasm.

I recommend icing when there is:

1. Less than 72 hours after injury, for example, after an ankle sprain.
2. A chronic (long term) injury that has recently become more aggravated.
3. Warmth and swelling of the area.

For small areas take an ice cube and massage it for 7 minutes or until it is numb, making sure you coat the skin with oil as a barrier against ice burns. For moderately sized areas, use an ice pack or a bag of frozen peas so it can wrap around the area. Don’t apply directly to the skin. A wet towel should be between the body and the ice.

Ice should be applied for 8 – 12 minutes depending on the thickness of the area. The thicker the area the more time is needed but do need exceed 15 minutes. Icing should be performed every two hours and not just once or twice.

When icing you should expect to first experience cold followed by burning, then achy and finally numbness.

Ice should not be used if you have:
1. Cold Hypersensitivity
2. Cold Allergy
3. Diabetes with vascular disease
4. Elderly with fragile skin

5. Impaired sensation e.g. numbness
6. Malignancy

7. Peripheral vascular disease.
8.Raynaud’s Disease (circulatory disorder where your fingers and toes often go white)
9. Rheumatoid Arthritis
Avoid icing the front of the neck, you could cut off the circulation to your brain.

Recently, there has been less emphasis of ice during acute injuries.  The reason behind this is that we want a certain amount of inflammation so that the healing process can occur, the stimulation of those white blood cells is all important in the recovery of the injury.  Ice may result in little or no inflammation which may not be sufficient for healing.  There is now a strong emphasis on using compression to limit the swelling in the injured area for the first 2 hours and then icing after this period.

When to apply Heat

Heat increases blood flow to an area which brings all of the vital nutrients needed for injury repair. In addition, it has a calming effect to relax muscles thus allowing them to be more flexible and in turn increasing mobility. Heat can also reduce pain as well as muscle spasm, depending on the circumstance.

Heat should NEVER be used immediately after an injury and not for up to 48 hours following the injury

I recommend heat when:
1. There are tight muscles.
2. The condition is chronic (long term).
3. When the injury is no longer inflamed or warm to the touch.

I recommend using moist heat. This can be done by soaking the area in a hot bath or heating up a wet towel until it is comfortably hot. Moist heat penetrates deep beyond the skin. If you are using a product that you heat up in the microwave then wrap this in a wet warm towel. Heating should be performed for 10 to 15 minutes. Check the skin every once in awhile to ensure that the skin is not burning.

Heat should not be used if there is:
1. Malignancy
2. Impaired sensation e.g. numbness
3. Infections
4. Impaired blood flow
5. Multiple sclerosis
6. Pregnancy
7. Deep vein thrombosis

The Grey Area

The grey area is that time where the client is beyond 48 hours after the injury. This is a time where we are not completely sure whether heat or cold is required. This is a typical situation. The client uses heat and they will feel good immediately after using it but then within a half hour or hour they experience feeling more stiff and tight. This is likely an indication that there is still an inflammatory process occurring therefore the patient should use ice.

 Contrast bathing is a good method to use after 72 hours following an injury. This method uses alternate ice and heat applications.

First ice the area for 10 minutes, then heat the area for 10 minutes and finally ice the area for 10 minutes. This method will speed up the recovery process, prevent unwanted swelling and improve mobility. You can repeat this every 2 hours. The same contraindications apply as above for ice and heat treatments