HOT or COLD – When to apply?

Osteoadvice: HEAT vs ICE

A question I have been asked more than any other this week is heat versus ice application. When should you apply ice to an injury and when is heat better suited?
The answer lies in the injury time frame: is it an acute injury or a chronic injury?

Acute injuries are sudden, sharp, and often traumatic, and occur immediately or within hours of the injurious event. Most often acute injuries will be caused by a fall, sprain or collision, and it is fairly obvious what has caused the injury (but not always!).
Common signs and symptoms of acute injuries include pain, tenderness, swelling, redness, skin warmth, and inflammation.

Chronic injuries however, can be subtle and slow to develop. They are often the result of overuse but can also develop from an acute injury that is not adequately managed and fails to heal properly.
Chronic injuries often cause dull pain and soreness, with little to no swelling or warmth.

Cold Therapy (Cryotherapy)

Cold therapy is the best immediate treatment for acute injuries. Ice is a vasoconstrictor (causes blood vessels to constrict) which will reduce the amount of internal bleeding, swelling, and inflammation at the site of injury. Remember our first aid principles when an acute injury occurs – R.I.C.E ( whilst doing no H.A.R.M (heat.alcohol.running.massage)!
Cold therapy is also useful in the management of some chronic or overuse injuries – when an overuse injury is acutely aggravated the inflammatory response may be reignited. Cold therapy can help to diminish this.

How to ice:

Wrap an ice pack in a tea towel and apply to the site of injury (ice should not be applied directly to the skin). The best ice packs will be flexible and conform to the injury site. A bag of frozen peas is the gold standard ice pack when an ice pack is not available.
Apply ice for 10-20 minutes, then remove for a further 10-20 minutes, allowing the skin temperature to return to normal. This procedure can be continued several times per day for up to three days (72hrs) post injury.

Heat therapy (Thermotherapy)

Heat therapy is best applied to chronic injuries and injuries without any inflammation and swelling. Heat increases circulation and skin temperature and should not be applied to injuries that exhibit signs of inflammation. Stiff and sore joint and muscular injuries are ideal for the use of heat therapy. The use of heat in chronic pain or injury can help to warm up before activity by increasing elasticity of joint connective tissues, promoting blood flow, and reducing tension in tight and spasmed muscles. Do not apply heat after exercise – ice is the best choice post exercise for a chronic injury that might have suffered a degree of re-aggravation.

How to heat:

Heat packs should be applied with enough layers between it and the skin to prevent burns. Apply to the injured area for 10-20 min at a time. Moist heat is most effective so try a hot wet towel if you do not have a heat pack available.

For more information on when to heat or ice and for specific advice as to the management of your condition, contact one of our Osteopaths today.

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