Heat or Ice?
Barely a day passes without one of our physios being asked “Should I put heat or ice on it?”. The best way to answer this question in general is to actually explain the factors that need consideration. Remember, ice is used to restrict circulation, and heat to increase circulation:
- How old is the injury? The acute inflammatory stage only lasts for around 14 days. Within this time period, most acute or sudden injuries respond well to ice rather than heat. The only consistent theme is that you should apply ice immediately after injury for 10-15 min every 2-3 hours for first 72 hours. After this, we need to determine what type of tissue the injury affects, and the extent of the injury as to how to manage it with heat or ice.
- What type of injury is it? Depending on whether the injury is muscular, ligament, disc, tendon, bone or nerve, icing and heating can have different effects. Muscular strains can start being heated before activity after only a couple of days, and even muscular tears after 5-10 days depending on bruising. Ligament sprains will respond much better to ice for the length of the injury – an ankle or knee ligament injury will need to be iced after activity for weeks and sometimes months, especially if there is persistent swelling. Same goes for post-surgery. And discs and tendons respond differently again, as they have a very poor blood supply and react different to thermal changes. This poor circulation means that discs and tendons can carry large loads for long periods without injury, and are generally slow to become injured, but also leads to slower healing rates once injured. In general, a disc or tendon injury that is longer than two weeks old (eg a classic Achilles tendinopathy) will respond much better to heat, as the heat will encourage circulation into the area and assist healing.
- Is there swelling? Swelling should be managed with regular elevation above heart level, and almost always with icing at the same time. As noted above, persistent swelling post injury or surgery will respond well to ongoing icing and elevation post activity, and compression bandaging during activity. In chronic tendon injuries, swelling can hang around for months, and a combination of heat and ice can be helpful to move and stop the build up of fluid.
- Is there reduced or increased skin sensation, or skin colour or temperature changes? This can indicate problems with the circulation or the nerve supply to the regional circulation, which is potentially dangerous to extreme temperatures. In general, don’t apply heat or ice if you can’t feel it, and seek advice before attempting to do so. If you do, no longer than 3-5 minutes and always have a barrier in between (eg cloth or towel).
- What does the person do for work/sport? If you have an active job, and your injury gets worse with activity, then rest and ice may be more beneficial than heat. If you have a sedentary job or lifestyle, then heat and activity may be more beneficial. Again, you physio can provide the best advice on an individual basis depending on your injury.
- Can I use both heat and ice? Yes, this can be effective especially after sport or activity. Elite athletes often use this system with ice baths and a warm plunge pool, varying time between both inmediately after activity. The ice helps reduce the inflammation from strains or knocks and the heat helps to improve circulation to the soft tissues, remove the build up of lactic acid and prevent post exercise soreness. You can use localised heat and ice for muscle soreness after activity, but be careful – if there is any bruising, bleeding or acute injury you must seek advice first.
For individual advice please ask you physiotherapist in your next session whether heat or ice is best for your problem.
