COLD VS. HEAT:
WHAT TO USE ON SPORTS INJURIES
by: Dr. Darrell M. Schreyer, D.C.

Should I apply ice or heat on my injury?

This is a question that is asked in my clinic almost every day. It is a question that people are very unsure of, and often misinformed.

Several patients have come to me after applying heat to an area they have previously injured. They almost always ask why they felt great during and immediately after the heat was removed but have felt much worse ever since. Although heat will decrease joint stiffness by reducing muscle spasms, it produces more swelling to the area by allowing damaged blood vessels to remain open. This action will not only increase the amount of pain, but also create a longer healing time. If the injured site is the spine or another joint of the body that has a large nerve supply, the swelling can also put more pressure on the nerve and cause further pain and damage. The primary goal in new injuries is to reduce the swelling as quickly as possible. Ice does so by decreasing blood vessel pressure, diminishing the amount of bleeding, and therefore aiding in the drainage necessary to reduce swelling. Ice is also deeper penetrating than heat, and can help heal damaged tissue further from the skin surface.

There are basically two classes of injuries; acute and chronic. Acute meaning a recent and intense problem, while chronic meaning a longer duration and less extreme injury, or one that reoccurs. The rule of thumb is ice for acute, and heat for chronic. Athletic injuries can fall under either of these two classes.

Any athlete with a sports injury wants to return to competitive form as soon as possible. With acute injuries such as sprains, strains, contusions and abrasions, the application of cold is probably the fastest and safest therapy available. The P.R.I.C.E. method is prescribed to athletes or patients presenting with the above problems:
P = protect the area from re-injury
R = rest
I = ice the injured site
C = compress
E = elevate

The most common form of using ice to treat an injury is the cold pack. There are many very good gel-filled cold packs on the market today. These are more efficient than cubes of ice or crushed ice put into a plastic bag, because they are more comfortable and provide a greater surface area of coverage than does cubes of ice. Cold packs should be applied with a thin towel between it and the skin to prevent frostbite, and with a duration of 20 minutes. This is recommended to be done every 1-2 waking hours for the first 48-72 hours after the injury.

The best treatment for bony areas or areas with little soft tissue, such as the ankle or elbow is with ice massage. Freeze water in a Styrofoam or Dixie cup, then peel the top away to leave enough of the cup bottom to hold onto. Using a circular motion, you can comfortably rub the ice directly on and around the injured site for 5-10 minutes.

The effects of the cold are a decrease in the amount of swelling in the area, an increase in the pain threshold, and a decrease in the amount of oxygen needed by the injured area.

When an injury reappears constantly, or is felt during or after every competition, or has become a dull ache that will not go away, it has become chronic. The application of cold therapy or ice is recommended immediately following the event. As was mentioned earlier, heat is less penetrating and must be maintained on the injured area longer (at least 30 minutes), for any effect to occur. Heat can be utilized in many ways, with one of the favorite being a whirlpool or spa. Other common ways are moist hot packs, hot baths or showers, or a wet towel warmed in the microwave oven. Heat should not be applied to areas of swelling or possible bleeding as both problems will increase, and therefore so will pain. Heat will decrease muscle spasm, increase circulation and heart rate, and sedate the nervous system.

In summary, utilize ice or cold therapy with any new injury, paying strict attention to the duration's mentioned above. With an old, nagging injury, try ice and if this doesn't seem to produce any results, then you can use heat.