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.

 

Ice

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

 

Heat

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!