Using Heat vs. Ice When Treating Athletic Injuries
Two of the most common treatments for a broad range of athletic injuries are the use of ice and heat. The question is: when to use which? An important factor in deciding which one to use is to determine which type of injury you have. There are typically two types of injuries, acute and chronic. Acute injuries are typically a sudden trauma, such as a fall or sprain and are less than 48 hours old. Chronic injuries are characterized by a delayed onset, such as overuse and symptoms are sometimes slow to develop.
When treating acute injuries, such as ankle sprains and contusions (bruises), it is best to use ice for at least the first 48 hours. The use of cold therapy will help limit the amount of swelling by constricting the blood vessels and help diminish the level of pain with the injury. Apply an ice bag directly to the injured area for 10-15 minutes, 2 to 4 times a day, for the first 48 hours. If the person is sensitive to the ice, place a thin moist towel or washcloth between the skin and the ice. Make sure the surface area warms back up all the way before repeating the treatment. Ice shouldn't be left on for more than 20 minutes for a couple of reasons. First, prolonged exposure can cause ice burn and second, after about 20 minutes the body will dilate the blood vessels in the area to combat the prolonged exposure to cold (Hunting's Response), thus reversing the desired effect.
If using an ice bucket or cold whirlpool, make sure the water is somewhere between 50 to 65 degrees Fahrenheit. Submerge the affected area for 10 to 15 minutes. Another form of cold application is ice massage. This is a very effective means in treating acute muscle contusions and strains. Fill a small Styrofoam or Dixie cup with water, freeze it and peel off the top third of the cup exposing the ice. Holding the cup upside-down, massage the affected area in a circular motion for 10 minutes. Make sure to keep the ice moving, so as not to produce a frostbite effect. After 48 hours, if there is minimal inflammation, then heat treatments can be started.
The ideal use for heat is with chronic injuries where there is little or no swelling. Muscle strains that don't seem to get better, stiff joints resulting from a fall and sprains that are more than 48 hours old are examples of injuries that would benefit from heat therapy. The rationale behind using heat on an injured area is to increase the blood flow to that area by dilating the blood vessels. This increased blood flow promotes healing and stimulates the formation of new cells. Moist heat has been found to be the most effective. Moist heat can be obtained simply by wrapping a hot, moist towel around a hot water bottle or over a non-electric heating-pad and applying to the area for 15-20 minutes. Heat shouldn't be applied for more than 20 minutes at a time and never sleep with a heating pad on an injured area.
If a heating pad is unavailable one can still obtain moist heat by placing a damp towel in the microwave for 1-2 minutes then applying to the effected area. Cover the injured area in heat for 10-15 minutes, but be careful that the heat is not too hot or blistering could occur. When using a warm whirlpool, the ideal temperature is 100 to 104 degrees Fahrenheit. Submerge the affected area for 10-15 minutes. For some, simply standing in a hot shower or soaking in a warm bath can be effective for injuries to the low back area. Heat is very effective in helping to warming up muscles prior to exercise and in reducing muscle tightness and spasm. For muscle strains, after the initial 48 hours, heating the area for 10-15 minutes, then gently stretching the muscle before activity is a good way to speed up recovery.
For some injuries, a mixture of ice and heat treatments is recommended. Chronic injuries that continue to have swelling seem to do well with contrast baths. Contrast baths are simply the alternation of ice and heat application. This combination acts as a “pump” in the tissue to remove waste products brought about by inflammation. If using a whirlpool (beneficial for ankle sprains), cool the area first for 8-10 minutes, then immediately switch to a warm bath for 5-10 minutes. Repeat this for 3-4 cycles a couple of times a day. The same can be done with ice bags and hot packs.
Many times, athletes will complain that they are not recovering fast enough from a sprain or strain, but then it is found out that they did not ice their injury initially and haven't been heating it since. A quick fix it is not, but the use of cold and heat therapy in athletic injuries is two of the easiest and simplest forms of treatment and will decrease recovery times undeniably. Other forms of treatments, such as stretching, exercise and therapeutic modalities in conjunction with cold and heat treatments will also speed up the recovery from an injury.
People get injured everyday, from bumps and bruises to sprains and strains. For all of these injuries it is important to remember the general rule of icing an acute injury for the first 48 to 72 hours, then, after the swelling has subsided, you can begin to add heat to the area. These guidelines can sometimes vary among injuries, so if in doubt, consult your physician, athletic trainer, or physical therapist.
Jason Crivello, ATC is a certified athletic trainer with KORT and is the head athletic trainer at Ballard High School and Ohio Valley Wrestling. He can be reached at the KORT-Springhurst Physical Therapy office. 502-339-4700.