Ice vs. Heat

This is probably the most commonly asked question that I hear in the clinic. Should I use ice or heat on my injury and for how long?

When an injury or trauma occurs such as a muscle strain (tear), a direct blow, fracture, etc. inflammation occurs due to rupture of tiny blood vessels surrounding the injury site. The increased volume of blood around the site causes pain, swelling, and bruising of the injured body part. Here are some FAQs regarding when and when not to use ice/heat for an injury.

ACUTE (NEW) INJURY:

Question: Should I use ice or heat?
Answer: Ice. Ice causes your blood vessels to constrict (narrow) in order to draw blood and inflammation away from the site of injury, which decreases pain and swelling. When using an ice pack be sure to place one layer of protection in between your skin and the ice pack (i.e. pillowcase). There are other forms of ice available for use instead of the traditional ice pack. These include ice cup or ice bath. The ice cup can be made by filling up a medium sized Dixie cup with water and freezing it. When ready to use you can rip the top half of the cup off so that the ice is exposed. Then, apply ice to injury site and massage the area by making small circles with moderate pressure for 6 minutes. The ice cup penetrates deeper than the traditional ice pack and is great for quick on-the-go application. The ice bath is very effective, however most are unable to tolerate placing their extremity in a bucket of ice water. First, you fill the bath or a bucket of water with ice and then place your affected extremity into the water for 4-6 minutes.

Question: How many minutes should I keep the ice on my injury?
Answer: You should use ice for 10-20 minutes max. If ice is used for more than 20 minutes it actually does the opposite of what we want it to do. It causes the blood vessels to dilate (widen) allowing increased blood to enter the area of injury. You can use this schedule when icing: 20 minutes on, 1 hour off and repeat 4-8 times per day. Also, make sure to periodically check your skin for ice burns.

Question: How many days should I use ice on my injury?
Answer: The inflammatory phase of healing last 2-4 days, therefore ice should be used up to 4 days following injury.

RECOVERY FROM INJURY:

Question: When I am recovering from an injury, when can I begin to use heat?
Answer: Heat may be applied to injury after day 4. Heat is excellent to use before exercise and/or stretching in order to increase blood flow and relax the muscle.

Question: How many minutes should I put heat on my injury for?
Answer: 10 minutes of heat will suffice prior to exercise. If you want to use it to relax your muscles you may also submerge your body or injury site in a nice, warm, relaxing bath for 20 minutes, twice a day. The water temperature should be between 92 to 96 degrees Fahrenheit.