Ice vs. Heat- When and What to Use
Two of the most commonly used modalities of rehabilitation clinicians, professional athletes and recreational athletes are ice and heat. However, there is a great deal of confusion and misunderstanding when it comes to using ice or heat. So when and which one should I use?
Cold therapy (or cryotherapy) is the use of a cold modality in the event of an acute trauma and subacute injury. The important use of cold therapy is to lower the temperature in the injured area reducing the metabolic rate and decreasing the production of metabolites and metabolic heat. Thus, cold therapy reduces additional damage to the injured tissue from the inflammatory response of the body. Other benefits of cold therapy include reducing muscle spasms and pain. Cold therapy includes ice packs, cold and ice whirlpools, ice massage, commercial chemical cold sprays and contrast baths.
With an acute trauma or subacute injury only cold treatments should be applied in the first 72 hours to reduce the accumulation of swelling (edema), pain, muscle spasm or guarding. Treatment times vary depending on several factors including the size of the treatment area, type of cold therapy applied and the size of the individual being treated. For example, a thin person requires less treatment time because the cold does not need to penetrate through as much tissue to lower the intramuscular temperature, thus producing the desired therapeutic effect.
There are four stages of cold that assist in determining the appropriate treatment time. The first stage of cold therapy is an uncomfortable feeling. Second, stinging. Third, burning or aching and finally numbness. It takes between five to fifteen minutes to reach all four stages. As a result, treatment time should be a minimum of fifteen minutes to achieve the important therapeutic effect of the treatment.
On the other spectrum, heat for the most part is the opposite of cold. Heat treatment (or thermotherapy) is recommended in subacute and chronic conditions for reducing pain and inflammation. The principal reasons for heat therapy application is to increase tissue temperatures, increasing blood flow, therefore drawing extra nutrients into the injured area to assist in the recovery and healing process. Because of this, heat should never be used on an acute trauma or injury until the swelling is controlled. The most common use of heat therapy is a moist or dry hot pack. Treatment time for heat is between fifteen and twenty minutes. Just like when using cold therapy, it takes heat a minimum of fifteen minutes to penetrate tissue to reach and raise temperatures. Other heat therapy applications include diathermy, ultrasound, warm whirlpool, paraffin bath, infrared lamps and fluidotherapy.
The application of cold and heat therapy can be safe, simple and inexpensive. The proper use of these modalities can assist the body during the healing process and help make the trauma or injury less stressful. Do not use these therapies for skin anesthesia or open wound care. If you are still unsure of which and what to use, contact a clinician and they will evaluate and apply the appropriate therapeutic modality to increase your chances of a quicker and less stressful recovery.
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Reference: Therapeutic Modalities in Sports Medicine 4th edition, William E. Prentice; Copyright 1999, pages 173 – 206.