Here's the deal:
Both Ice (or cryotherapy) and heat (thermotherapy) are low risk, cheap, and highly effective self management strategies used to help an injury. However, they will NOT "fix" the problem.
We discuss what to use and when to use it!
So, to know what to use and when to use it, we need to go through some basic human anatomy.
What do we need to go through specifically? Inflammation.
Inflammation is your body's own self protecting mechanism. It is a normal and healthy response to an injury. It aims to protect and preserve the good, and take away the bad. When a tissue is damaged, i.e torn ligaments, muscle tears, whiplash injuries, or a strained back, our body responds with a sequence of chemical and neurological changes. These changes essentially flood the injured tissue with fresh blood, bringing in oxygen and nutrients. With this fresh blood comes cells from our immune system, designed to protect the tissue and commence the rebuilding/healing process.
This immune system response brings the heat, pain and discomfort we commonly associate with inflammation (1).
"Inflammation is a normal and healthy response to an injury"
That said, we can now better understand what to use and when to use it.
Best used for acute or "fresh" injuries!
Ice is a natural and chemical free analgesic. When an injury is "fresh" and caused by a sudden trauma or tearing, heat and inflammation begin to rush in. Ice helps to cool and calm damaged tissues and acts to dull the pain associated with inflammation. Adding heat to an already hot and inflamed tissue will only further exacerbate your pain.
Best used for chronic pain, non-inflammatory conditions, soreness and stiffness!
Heat, like ice, is no miracle "fixer" of injuries. Heat helps to promote circulation, eliminating any debris and waste products. Also, the warming of sore and stiff muscles and joints can create an analgesic effect. It should be noted that heating is fairly superficial, penetrating approximately only 2-3cm of the skin. Therefore deeper muscle injuries may not receive the full benefit of heat packs. To heat tissue's deeper than 2-3cm, an ultrasound modality is used but lets save that for another time.
It is interesting to note that heat can be applied as early as 4-5 days post acute injury, once inflammation, swelling and redness has reduced (1). However AVOID heat in the first 72 hrs post injury!
The Exception to Conventional Wisdom
Back pain experts estimate 85% of back pain is idiopathic, meaning it is "unexplained" (2). With back pain and spasms, unless the injury is a trauma or whiplash causing tissue damage, the application of heat is advised. Icing is unable to effectively reduce inflammation as the tissues in the back are simply too thick for the cold to penetrate.
In the case of neuropathic pain, (nerve pain), from clinical experience, it is advised to follow an icing protocol as heat may exacerbate your pain.
Conventional icing protocols involve:
20 minutes on every 2 hrs for the first 72hrs.
However, research has shown less pain can be achieved in the first week by following an intermittent approach of:
10 - 10 - 10 - 2
That is, 10 min on, 10 min off, 10 min off and repeat every 2 hrs for the first 72 hrs.
This approach has proven to be more successful at maintaining damaged tissues at the optimum temperature of 10-15 degrees for longer than the standard 20 minute approach (3). This reduction in pain can help us to commence treatment sooner, minimising your time off the field, training and ultimately, competing.
Whats the bottom line:
When you have an "OHH CRAP!" moment after you have lifted something heavy or performed a quick sharp twist on the field and suddenly there's pain = Ice
When the skin is sensitive, swollen, red and puffy = Ice
When you've hoped out of bed and are feeling stiff and sore = Heat
Listen to your body:
If you're hot and sweaty, don't use heat.
If you're shivering and can't seem to feel your toes, don't use ice.
I hope this helps clarify the important differences between the two self treating strategies. Apply these tips next time you experience an injury on the sporting field or at work and are feeling sore.
If you have any questions or would like any further explanation shoot me an email or call on 0435 819 286.
1. Garra G, Singer AJ, Leno R, et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med. 2010 May;17(5):484–9
2. Deyo RA, Weinstein DO. Low Back Pain. N Engl J Med. 2001 Feb;344(5):363–70.
3. C M Bleakley, S M McDonough, and D C MacAuley. Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med. 2006 Aug; 40(8): 700–705.
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