Monday, 21 January 2013

To ICE or to HEAT, that is the question!

We have all applied ice or heat to an injury, but are we applying them at the right time? Many people tell me they are applying heat to an injury when they should be icing, others tell me they have been icing when they would benefit from heat. Then there is the group of people that does not do either because they are unsure what they should be using when! This post will clarify when to use ice and heat.





What do they do?
Ice is a vasoconstrictor.  This means your blood vessels tighten and less blood is able to enter the area where the ice is applied.  Heat on the other hand is a vasodilator.  This makes your blood vessels expand and draws blood and nutrients to the tissue. 

When to use them?
To understand when to use ice and heat you must first understand how the body responds to different types of injuries.  To make it easy we will separate injuries into 2 categories, acute and chronic.  Acute injuries are injuries that recently happened, and have active inflammation (an excess of blood entering the area).  Examples of acute injuries are receiving a blow to the leg in a contact sport, spraining your ankle during a basketball game, and a disc herniation.  Chronic injuries are long standing injuries that have low grade inflammation.  Examples of chronic injuries are spinal arthritis, a degenerative meniscal tear, or repetitive strain injuries such as tennis elbow, or postural strains. 


Ice and heat with acute injuries
When you damage body tissue during an acute injury, your body responds by driving blood to the area, which increases pressure that can cause pain. Ice is great in this situation because it will decrease the diameter of the vessels and allow less blood to the injured area, which will lead to decreased pain, and faster recovery times.   Avoid applying heat in acute situations because more blood will enter the area and will exacerbate the inflammation, which will lead to increased pain and prolonged healing time. 

Ice and heat with chronic injuries
Chronic injuries tend to linger, and for one reason or another don’t necessarily heal well.  These are the “aches and pains” that we deal with day to day and they have a tendency to cause stiffness in the morning or after long periods of rest and loosen up as the day goes on.  As you loosen up and start to regain motion throughout the day low-grade inflammation is flushed out of the injured area, but as you feel better the increased movement can irritate damaged tissue and lead to more low-grade inflammation.  During periods of inactivity (sleep), the inflammation settles and then you will be stiff when you start moving again (getting out of bed).  Ice is used in chronic injuries to limit inflammation just like in acute injuries.  However, the icing will be more beneficial after exercising, after a long day, and before bed.  Heat on the other hand is great to loosen up tissues before exercise or work, relax muscles, and increase tissue elasticity.

Application
You can use an ice pack, crushed ice with water (to conform better), or frozen veggies.  If using an ice pack place a thin cloth between the skin and pack.  Ice the injury for ten minutes.  Take the ice off for a minimum of 10 minutes or let the skin return to normal temperature before reapplication.  Since icing is not the most comfortable sensation I tell patients to reapply until they don’t want to ice anymore and then do it one more time.  Be careful not to leave ice on direct skin for too long as frost nip may occur. 

Heating pads, hot packs, warm moist towels, warm baths or tissue massage are all ways to heat an area.  Heat for 10-20mins.
Important!

Products like Deep cold and Biofreeze may be misleading.  They are for pain relief but do not provide the benefits of icing.  Products like traumeel and arnica gel are natural anti-inflammatory oitments that are great when ice is not available.  Be sure to apply with light pressure as firm massage will heat the injured area.

Finally, although icing is good for numbing pain, it is detrimental to use before exercise or returning to play.   Icing may decrease muscle performance, decrease fine motor control and maybe limit your proprioception (awareness of that body part in space).  All of these will put you at higher risk for further injury.

So, next time you get an injury, refer back to this page so you can be assured you are taking care of your injury the right way!



Until next time, stay healthy my friends,

Dr. Adam


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