USE OF HEAT
Effects of heat: Increases circulations, metabolic activity, and inflammation.
Benefits of heat: improves compliance of soft tissues, relieves pain and spasm. Heat is most useful in warming up stiff or scarred soft tissues before stretching or exercise; heat may also be useful in relieving pain or spasm associated with neck or back injuries.
Risks of heat: May increase swelling and inflammation; using heat for too long or at temperatures that are too high can cause burns.
Methods for applying heat: Hot packs, hydrocollator; hot bath/whirlpool. May use either dry or moist heat.
When not to use heat:
- After physical activity
- If the area is numb
- If there is an open wound or burn
- Immediately after an acute injury
- If body temperature is elevated from fever or heat stress
USE OF ICE
Effects of ice: Reduces swelling, decreases circulation and numbs the skin. Best used after exercise or after pain-producing activing.
Risks of Ice: Prolonged use can cause frostbite (Greater than 20 minutes).
Methods for apply cold therapy: Ice packs, ice bath/ice whirlpool, ice massage.
When not to ice:
- Immediately before physical activity
- If area of icing is numb (be careful with skin that is numb due to surgery)
- When the pain or swelling involves a nerve (such as the ulnar nerve or “funny bone”)
- If you have sympathetic dysfunction (an abnormality of nerves that control blood flow and sweat gland activity)
- If you have vascular disease (such as poor circulation due to blood loss, blood vessel injury, compartment syndrome, vasculitis, blood clots, or Raynaud disease.
- If there is skin compromise (such as an open wound: a wound that has not healed; skin that is stretched, blistered burned, or thin)
- If you have cold hypersensitivity, including cold-induced urticarial (hives from cold)
How long to use ice:
- Two to three times per day (minimum): up to once per hour.
- Duration varies with technique; usually 20 minutes per session
- Ice may continue to be useful in treatment as long as there is pain, swelling, inflammation, or spasm. There is no need to switch to heat after 48 hours or alternate between ice and heat.
Options for Applying ice:
- Ice packs
- Small cubes or crushed ice in plastic bag
- Bag of frozen vegetables (such as frozen peas)
- Reusable commercial ice pack or circulating “cryocuff” (made specifically for therapeutic icing). Do not use blue ice packs directly on the skin; they are colder than frozen water and can cause frostbite.
- Method: Place on the affected area for at least 20 minutes per session. Hold in place with a towel, elastic wrap, ace bandage, or shrink-wrap. Ice bath/ice whirlpool is used with supervision of an athletic trainer or physical therapist.
- Ice massage is used to reduce superficial, well-localized inflammation (for example, tendonitis of the hand, wrist, or elbow; heel or elbow bursitis; ganglion cyst; apophysitis; or irritation of the growth plate).
- Materials: ice cube or frozen ice cup (made by freezing water in a paper or Styrofoam cup).
- Method: rub ice in a circulator pattern over the affected region for 8 to 10 minutes per session.
ADDITIONAL INFORMATION
Icing may be used along with compression, elevation, bracing and/or support when treating acute injuries.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can produce a similar effect to icing. If your doctor recommends medicine, make sure you are aware of the right dosage and when to take it, and if there are any side effects.
The use of ice and heat is just one part of a treatment program. Even if symptoms are relieved, there is usually a need for exercises to restore flexibility and joint motion, strength, general fitness, and sport-specific skills.