Should you use heat or ice for your backache, sprain, or other injury?

Both heat and ice have been used for thousands of years to treat injury and pain, but how do you know which one to use? Read this brief article to gain a general understanding of the injury process in your body, and then follow a few simple rules and you can make the right decision each time.

TWO TYPES OF INJURIES

There are two basic types of injuries; acute and chronic. An acute injury is a sudden injury that has just occurred such as a sprained ankle. You will usually know when have sustained an acute injury. A chronic injury is a more “long term” injury. It can be a former acute injury that is healing, or a long term aching back. These two types of injuries are treated differently.

Acute Injury – Use Ice!

If you injured yourself during the last 48 hours, or if your injury shows any signs of redness or swelling (inflammation) use ice on your injury. Ice reduces swelling by constricting your blood vessels and slowing the leakage of fluids into your tissues from the injury. Reducing swelling helps the injury heal quicker and reduces the amount of pain you experience. Ice should also be used on chronic injuries that have been inflamed or “reinjured”. For example, let’s say you are recovering from a sprained ankle that occurred several weeks ago (therefore, it is now in the chronic stage). Then today you decide to hike to Humphreys Peak (highest point in Arizona) and your ankle is killing you when you finish. Well, the chances are that you reinjured your ankle to some degree and now require ice. Anytime your chronic pain flares up after exercise, ice is the appropriate treatment. As a rule, it never hurts to put ice on an injury or area of pain, as long as you follow the correct procedures (shown later in this article).
When to use Ice

• Immediately after an injury (sooner the better)
• The first 48 hours after an injury
• Anytime there is swelling or other signs of inflammation
• After exercise or exertion when you experience a flare up of a chronic pain

When Not to Use Ice

• Never use on a sore muscle before exercise. This will increase the risk of injury.
• Never use ice while sleeping.

Does and Don’ts of Applying Ice

• Don’t put ice directly against your skin unless you are performing an ice massage. An ice massage requires you to move the ice around on the affected area continuously (Ice Massage works great…Just use something to hold the ice so your hand does not freeze). Never leave an ice pack, etc. directly on your skin. Always place a towel or other material between the ice and your skin.
• Don’t use ice for more than 20 minutes at one time (less time on a smaller muscle or on small children). Longer usage can cause frostbite resulting in severe damage to your tissues.
• Do allow your body to warm up to room temperature naturally after applying ice (warm up takes 45 minutes to an hour).
• Do apply ice several times during the day as long as you let the area warm up in between uses.
• Don’t apply ice before exercise! This will increase your risk of injury.
• Do use a container (like a zip lock bag) that will contour to your body. A small amount of water can be placed in a zip lock bag with the ice to help this.

When using ice you may experience the following sensations, which are very natural (C.B.A.N.):
C – Cold!
B – Burning
A – Aching
N – Numbness – When you are numb you are done and can take the ice off! (Don’t exceed 20 minutes even if you don’t feel numb).

Chronic Injury – Use Heat (usually!)
Chronic pain or long term injuries usually respond best to heat. Stiff, sore muscles or joint pain is the ideal case to use heat. Heat dilates your blood vessels and increases circulation bringing blood, oxygen, and nutrients to the affected area. Basic massage therapy works the same way. One of the main goals when massaging sore muscles is to increase circulation to the muscle. Heat helps relax your muscles, increases flexibility, and reduces pain and soreness.
Once your formerly acute injury begins to heal and the inflammation goes down, you should start using heat (about 48 – 72 hours after the injury). For that sore back with no apparent acute injury that caused it, heat is also great.
Unlike ice, which can be used almost anytime safely, using heat at the wrong time will make your situation worse. Never use heat when swelling, redness, or other signs of inflammation are present. Heat will increase your inflammation, irritating your injury.
When to use Heat

• On sore muscles and joints that have not be recently injured
• On stiff and inflexible muscles (some causes of pain and inflexibility are related to chronic contractions or trigger points that can only be relieved by Medical Massage Therapy.
• Before exercise on muscles that chronically cause you problems (this is another way to warm up first).

When Not to Use Heat

• Never use when an injury has just occurred
• Never use when there are signs of inflammation (swelling, redness, heat).
• Never use on someone with sensory problems (they could be burned inadvertently)
• Never use heat while sleeping

Does and Don’ts of Applying Heat

• Do put the heat directly against your skin. Hot towels and heating pads work great.
• Do use heat for as long as you wish, as many times as you wish.
• Don’t burn yourself! The temperature of the heat can be as hot as you can take it without burning yourself. Be careful, especially with children and the elderly or those with reduced sensitivity to pain.
• Don’t apply heat after exercise. Use ice after and heat before exercise.

IMPORTANT INFORMATION – The above information is general advice only. If you are injured you should seek specific advice from a doctor or other medical professional.