Health & Safety Resources

Ice vs. Heat to Treat Injuries

Ice or heat?  Heat or ice?  Most athletes and coaches know to apply ice to a new injury but are not sure when to use heat.  Below you will find some guidelines to help you determine which treatment to use in which situation.

There are two basic types of injuries: acute and chronic.  Acute injuries are injuries that happen suddenly, most often resulting from some type of trauma, collision, twisting motion or a fall.  Chronic injuries, on the other hand, are injuries that last for months or even years.  They are usually slow to develop and often are caused by overuse or when an injury is not treated properly in the acute stage.        

The use of Ice (Cryotherapy) in the form of ice packs, ice massage, etc., is the best way to treat an acute injury.  Ice will decrease blood flow, pain, swelling, and inflammation.   With any acute injury ice/cold should be applied for the first 72 hours, however, depending on the severity of the injury, ice, compression, elevation, and rest may be used immediately following the injury for up to several weeks.  It is indicated in soft tissue injuries such as sprains, strains, contusions (bruises) and muscle spasms.  

Cryotherapy is also used for some chronic inflammatory conditions such as tendonitis.  If an acute inflammation reaction fails to be resolved in 1 month, it is termed a sub-acute inflammation.  If it lasts for months or even years, the condition is termed chronic.  Chronic inflammation can stem from repeated acute micro-traumas and overuse.  Athletes that have chronic pain or injuries may use heat therapy before exercise to increase their flexibility and to stimulate blood flow. However, after a work out, ice is the better choice to decrease inflammation of a chronic injury.   
      
The best way to ice an injury is by using a plastic bag filled with ice cubes or shaved ice; flexible gel cold pack or a bag of frozen vegetables to conform to the area.  A damp towel may be placed between the ice pack and the skin to help prevent the skin from frost bite like symptoms.  Apply for 15 – 20 minutes. 

Ice massage is another way to apply cryotherapy. Typically the ice is frozen in a paper cup and can be rubbed or massaged directly onto the skin surface. The top of the cup is then torn off and the lower part of the cup can be used to hold the large ice cube.  The large piece of ice is then rubbed on the area until the skin becomes bright pink in color or for about 7 - 10 minutes.  

When cryotherapy is applied the athlete will feel cold, then burning, followed by aching and, finally, numbness after the cold has been applied for a period of time.  Cold applications can be repeated several times daily, but not more than once every 1-2 hours to allow the skin temperature to return to normal.
           
R.I.C.E. therapy:  RICE is an acronym for Rest, Ice, Compression, and Elevation.
Cryotherapy combined with compression and elevation of the involved body part is the most effective way to reduce pain, bleeding and swelling of an extremity. 

Ice should not be applied to an area that has circulatory problems or hypersensitivity to cold.  Prolonged application can result in skin damage, blisters or frostbite. 

Thermotherapy, or heat application, has the opposite effect of cryotherapy in that it produces an immediate increase in local circulation and temperature.  As a result swelling is increased.  That is why using heat is contraindicated in acute injuries. Heat is generally used for chronic injuries or injuries that have no inflammation or swelling.    

The primary use of superficial heat treatments is to decrease muscle/joint soreness and stiffness.  It is also used to relax tight muscles or muscles that are in a spasm. 

Superficial heat can be applied by using commercial hot packs, heating pads or warm whirlpools.  A layer of toweling may be placed between the heat source and the skin.  Heat should not be applied for greater than 15 – 20 minutes at a time or used while sleeping.    

When in doubt, ice is always the better choice.

For further information on this article or for priority appointments for sport injures please contact Henry Ford Center for Athletic Medicine at 313 972-4216.

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs.  The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists.  These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab.  HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.