Heat or Ice in Injury Treatment?

A couple of incidents this week had me scurrying for my icepacks, so I thought it might be useful to take a look at ice and heat treatment. So here’s the conventional wisdom on the topic.


Generally, ice is used in acute injuries. These are generally caused by trauma, such as rolling your ankle, twisting your knee. Acute pain refers to any specific sharp, pain with rapid onset, so does not necessarily have to be associated with trauma, but often is.  Chronic injuries are more generally overuse injuries, or acute injuries which have not healed properly and have hung around. Chronic injuries have usually developed slowly over time and are persistent and long lasting.



Use ice

  • As soon as possible after an acute injury such as a sprain.
  • If you re-aggravate a chronic injury, such as shin splints.
  • If you’re brave enough, an ice bath will help with muscle recovery after long training runs or races!

Ice treatment promotes:

  •  Pain relief
  • Prevention or reduction of localised swelling after acute injury. It’s best combined with a compression bandage
  •  Prevention or reduction of bleeding in combination with compression
  • Reduction of inflammation



Use heat on:

  •  Chronic injuries which have been present for over a month without improvement, but have not become worse within the last week or so.
  • Chronic conditions such as plantar fasciiosis, BEFORE activity but never after activity or on a newly injured area.

Avoid using heat:

  • On acute inflammatory injuries such as ankle sprains – it can increase swelling and bleeding around the injury
  • On acute Rheumatoid Arthritis
  • Over an area of recent or potential bleeding
  • On thrombosis or other areas of impaired circulation
  • For Lymphoedema
  •  Over or near malignant tissue
  • People with neuropathy such as caused by diabetes or other impaired sensation
  • Over open wounds
  • Over areas of metal implants

Heat treatment promotes:

  •  Relaxation of tense muscles/reduction of muscle spasm
  • Pain relief (but not in acute inflammation or with an inflammatory condition-any condition which ends in it is, such as tendonitis, is an inflammatory condition)
  • Increased joint range of movement and decreased stiffness in a joint
  • Blood flow to the injured area (important for delivering nutrients)


How To Ice an Injury

Icing an injury is an important aspect of the R.I.C.E.R principal (See below)


  • Most effective in the first 48-72 hours after an injury-efficacy diminishes significantly after 72 hrs.
  • for acute injuries-ice for the first 24-48 hrs
  • for chronic injuries such as shin splints, ice after activity if you’re feeling pain in the injured area
  • ice for 10-15 minutes, and no longer than 20
  • ice packs should be placed in a cloth so the cold pack is not in direct contact with the skin
  • Ice massage can be performed with ice in contact with the skin.


Ice Massage

Great for shin splints. Simply rub an iceblock over the effected area. It can generally deliver a greater drop in temperature without the risk of ice burn. Use your standard every day ice cube, or fill a polystyrene cup with water and freeze it. You can then peel the polystyrene off the ice a bit at a time so that you expose some of the ice block whilst still having something to hold onto. If you come up with a more environmentally friendly version of this, let me know.


What is the RICER principal?

R is for Rest: Resting means avoiding as much movement or weight bearing in the injured area as possible to reduce further damage.
I is for Ice: for 10-15 minutes every 2-4 hours in the first 24 hours and every 4 hours after, for up to 72 hours.  Ice cools the tissue and reduces pain, swelling and bleeding.
C is for Compression: cover the injured area with moderately tight (not too tight) bandage including the areas above and below the injury. Compression reduces bleeding and swelling.
E is for Elevation: Keep the injured body part elevated above the heart while icing to further reduce swelling.
R is for Referral: Refer the injured person to a qualified professional such as a doctor, podiatrist or physiotherapist for precise diagnosis, ongoing care and treatment.
So, there you have it. The lowdown on the conventional way to use heat and ice in the treatment of injury.


I have frequently wondered why we try to inhibit the body’s natural reaction to acute injury. I’ve never really got a satisfactory answer from physios and doctors, so I’m off to do a bit more probing into why we do it. It seems counter intuitive to me, and always has. So stayed tuned. I may just find some supporting evidence which turns the theory on the use of ice treatment in acute injury on it’s head!

How Three Minutes of Exercise Per Week Can Improve Your Health

Three minutes of exercise a week will improve your healthKind of gets your attention, doesn’t it?

A recent documentary from the BBC’s Horizon Team, (the same guys who gave us the fascinating doco on Fasting), looked at two main areas of exercise and their health benefits.

Firstly, using presenter Michael Mosley as the guinea pig, the team looked at the type and quantity of exercise required to reduce the risk of heart disease and diabetes.

There are two significant markers of health relating to the development of these two diseases, blood glucose levels and Maximum Volume of Oxygen Uptake.


Blood Glucose When we take food it, it starts to be broken down in the mouth (both mechanically by chewing, and chemically with saliva), and then continues to be broken down in the gut. The nutrients leave the gut and enter the blood stream. The blood then transports the nutrients from the broken down food to areas of the body where they are needed. The speed with which the body can deal with an intake of sugar/carbohydrate by transporting it from the blood into the cells is important for maintaining blood glucose levels. The body’s ability to maintain a healthy blood glucose level is a significant health marker.


When our body loses its ability to transport sugar from our blood into our cells, a chronic high blood glucose level develops, which becomes toxic, destroying cells in particular parts of the body. You would have heard of this condition, it’s called DIABETES.


Maximum Volume of Oxygen Uptake (Max VO2)

This is the maximum amount of oxygen we can uptake and use during aerobic activity (the type of activity that gets you huffing and puffing). A higher figure means our cardiovascular system is strong and helps reduce the risk of heart disease.


High-Intensity Interval Training (HIIT)-Just Three Minutes Per Week

Researchers have found that performing very high intensity exercise for very short periods of time improves the body’s ability to move glucose out of the bloodstream — where it can become toxic and lead to the build-up of dangerous visceral fat (fat surrounding organs) — and into muscle tissue, where it is of benefit.


They have found that just three twenty second intervals of this high intensity exercise, three times per week WILL HAVE SIGNIFICANT EFFECTS on both glucose levels and Max VO2.


The Workout

The exercise is best performed on a stationary bike for ease of monitoring time and controlling the resistance, and to improve consistency of training.

Warmup Even though the “selling” point of the workout is 3 mins of exercise per week, you do actually need to do a bit more than that. You need to warm up first so that your body can reach close to maximal effort.

The Session Pedal hard, hard as you can, go like the clappers, for 20 seconds. Then take a breather. Then do it again, and again. Total is 1 minute of high intensity exercise.

Cool Down I’d advise at least a couple of minutes (though 5 mins would be better) of slow cycling to cool down to help pump your blood out of the working muscles more quickly.


Perform 3 times per week for 12 weeks and according to the latest research, you body’s ability to handle blood glucose will significantly improve.


Incidental Exercise

The other area of exercise which the documentary looked at was incidental exercise, This exercise is part of everyday living: going to the coffee machine, the photocopier, taking the stairs instead of a lift, walking to the shops, washing your own car, household chores, and playing with the kids.


It’s quite easy to accumulate a net 500 calorie deficit a day by increasing your incidental exercise. Walk a little further and a little faster. This 500 calorie energy expenditure is not only important in burning excess body fat, but helps in ‘oiling the wheels’ of our body. Pumping the heart that little bit more, moving blood and oxygen around, contracting muscles are all essential in reducing the risk of heart disease and cancer, two of the big premature killers today.


The Bottom Line

The notion that three minutes a week of HIIT can replace all other exercise and cater for every aspect of fitness is not one that sits well with me. It is sufficient for some aspects of fitness, but the documentary tends to over simplify and gives a misleading message. HIIT would seem to be useful in modifying blood sugar levels, but other studies also show that just getting up and walking around every twenty minutes or so will do the same.

So, if what you want to get from exercise is a reduction in your risk of heart disease and diabetes, knock yourself out doing HIIT three times per week. I’d caution against this if you don’t’ have a good level of fitness already, and my advice would be to build up slowly to this very high level of intensity over a number of months. Like anything new, build up to new levels of intensity or volume slowly.

But if you exercise because you enjoy it, or it makes you feel good, or you like being strong, or you like the social interaction, or you like the clarity of thought you gain from running on your own and getting away form it all, you like your muscles, you like strong tendons, you like your joints to work well, you like the endorphins, you like sweating, you like training for an event and feeling a sense of achievement when you complete it, you don’t like the quick fix attitude of our society, don’t give up on the more traditional exercise routines just yet.

Do include more incidental exercise in your day, and by all means, include HIIT as part of your overall exercise plan, as long as you work up to it gradually. After all, it is only three minutes per week.

Are Your Kids Being Mis-Treated

kid eating sweetAn interesting question which comes up for discussion in my line of work fairly frequently is “How do you get around your kids being given “treats” by their soccer coach/tennis coach/doctor/teacher/other authority figure. In many cases, quite young kids attend sports training sessions or events, and at the end of the session, all the kids line up and receive a lolly. It’s something I’ve heard time and time again, and I’ve had similar experiences with my own kids. Having sports coaches (or doctors or teachers) giving kids lollies just sends such a bad massage. These are the people who kids generally look up to, who kids model their health related behaviour on, and it simply isn’t healthy for kids to be given a sugar hit at the drop of a hat. In the case of sporting activities, these are often not every-so-often event. They are every week, each and every time a child attends a session.


“But it’s just a little treat”! Yes, it is just a little treat, but when so many people are giving your kids little treats, it turns into one constant stream of treats. It becomes the norm.


Week two of year one for my youngest son and cupcakes were on the menu for someone’s birthday. That’s fine, I knew it was happening and I could adjust anything else he was eating accordingly. Same day, a very kind hearted parent brought iceblocks to the school for all of his class because it was such a hot day. Great idea, and very nice gesture, but for most kids it meant two lots of junkish food in one day. It also meant that the frozen watermelon balls I’d so lovingly prepared for my boys to have for afternoon tea had to wait for another day! I miss out on sharing the guilty pleasure of a chocolate popped into the mouth when no-one’s looking, the stop off at the bakery on the way home from school for am apple turnover, because someone else has already got there with the junk food before me.


It’s hard to resist yummy stuff when it’s offered to you, even more so when you’re a kid. Even more so when it’s offered to you by someone who is teaching you about good health – a tennis coach, a soccer coach, a doctor a teacher…. you get my drift. So it’s our job to make sure our kids have a healthy diet. And the only way we can do that is if people don’t keep mis-treating our kids.


No-one else knows what my kids have been eating – they could have been on a 2-day food fest and are now not eating junk for a month. The point is, each family is different, each kid’s eating habits are different and we should take that into consideration when considering whether it’s appropriate to offer kids a “treat”.


Stop the press. My six year old has just this very minute come home with a chocolate from one of the girls in his class for Valentines Day (not that she has a soft spot for him, everyone got one). So this week (so far) it’s been one cup cake, one iceblock, one rather delicious looking heart shaped chocolate. This is what I know he’s been given. On offer also this week at school have been iceblocks being sold for the year six fund raising effort!

Take a look at the extra calories kids are given in the couple of weeks before Christmas.


So what can you do about it?

  • Firstly, be polite when you are asking people not to give your kids sweets. No matter how much your blood may be boiling, keep calm and try to explain why you don’t want that for your child. Come up with another suggestion. When my kids did Minitots soccer – a great soccer program for pre-schoolers, which handed out sweets at the end of a short session of soccer skills, I simply said they weren’t to have lollies, and perhaps a sticker would be appropriate (I really thought nothing would have been more appropriate, but thought that may have been pushing it).
  • Let your child’s teacher know how you feel and ask them to make sure your child brings home any cupcakes, lollies etc he’s been given so that YOU can decide when and if they have them
  • Talk to your children to try to get them to understand why it’s important for them not to just take every bit of junk food that comes their way. My kids both spent 4 yrs at long day care having rice crackers and homus or tahini, or their favourite, vegemite and avocado, for morning and afternoon tea instead of the biscuits and cakes which were standard fare. They still shared birthday cakes It didn’t seem to bother them that much, but my oldest hasn’t eaten avocado in a while come to think of it.
  • Try to let your kids have a part in the decision making process of whether or not they should eat something. I try to get them to think about what else they’ve been eating lately. We also look at the amount of calories in some things, and then decide if it’s worthwhile giving up half their dinner for a couple of lollies.


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