When we injure and damage tissue a natural inflammatory process is triggered by the damaged tissue and this is a vital step in your body’s response to the injury and repair process. However, the tissue can quickly become swollen and painful and the application of cold therapy as early as possible after the injury will help to reduce the extent of inflammation and consequent pain that follows.
How does cold therapy work?
Basically when the tissue is cooled the ice acts as a vasoconstrictor, by this we mean it causes the blood vessels to narrow which intern helps to reduce any internal bleeding and swelling at the injury site. This further helps reduce pain and any muscular and joint stiffness that occurs when the localised tissue becomes engorged with the increased tissue fluid as a result of the damage.
What is ice best used for?
Ice is most effective when applied as early as possible after injury. The injury will be a new injury that has come on suddenly (or within hours) following a sudden or sharp twist, strain, knock or impact type trauma. These are normally referred to as acute injuries. Ice can also be used for some longer standing chronic injuries that have flared up following activity, for example chondromalacia patella.
How do I ice?
There are various ways to ice an injury. Ice packs, wheat bags that are cooled in the freezer or simply a pack of frozen vegetables wrapped in a thin towel can all be applied to the site of injury with good effect. Applying light compression with the ice pack is also beneficial.
How long do I ice an Injury for?
The most important aspect of icing your injury is not to cause further damage to the tissue. Conditions such as ice burn which can often lead to frostbite can occur by applying ice to the area for too long. So, when you have your chosen ice pack ready consider the following:
- Never apply the ice directly to the skin. Always place a barrier between the ice and your skin. This maybe the towel the ice is wrapped in, a plastic sheet or bag (but not the bag the frozen peas are in as this should not contact the skin) or the outer cover of the wheat bag.
- When applying the ice firstly check the skin colour and then after 5 minutes recheck the skin colour to make sure it is not going red or bright pink. If the skin colour is ok then reapply but check again at 5 minute intervals to be sure you are not causing ice burn damage.
- Do not exceed 10-15 minutes of icing at a time. Take care not to exceed 10 minutes if the injury site has little muscle or fat over the area, for example on a twisted ankle.
- After 10-15 minutes allow the skin temperature to return to normal over a period of at least 45 minutes before you consider repeating the above. You can repeat the above as often as you like but be sure the skin has firstly returned to a normal temperature and has a normal sensation when touched.
- You can ice an injury over a period of 2 to 3 days.
How does heat therapy work?
Heat causes vasodilation which increases the blood circulation to the site. This has a localised soothing effect which helps to reduce muscle spasm and pain and loosen stiff joints.
What is it best used for?
Heat is beneficial for chronic injuries that have no swelling or inflammation present. Do not use heat on an acute injury. Stiff and achy muscles, joints and backs respond well to heat.
How do I heat?
There are various ways to do this. A warm water bottle, heat pad or wheat bag are all effective options.
How long should I heat for?
The most important aspect of heating your chronic injury is not to cause further damage to the tissue.
- The heat should be warm not boiling hot and always use a barrier such as the wheat bag or water bottle cover between the heat source and your skin to prevent skin damage.
- When applying the heat firstly check the skin colour and then after 5 minutes recheck the skin colour and look for any signs of overheating. If the skin colour is ok then reapply but check again at 5 minute intervals to be sure you are not causing any damage.
- You can use heat for up to 15-20 minutes at a time. Allow at least 45 minutes before reapplying heat.
Do not use hot or cold therapy:
- Over areas of skin that are numb or have poor hot/cold sensation.
- Over areas with poor/reduced circulation.
- Over areas of infection.
- If you have a diabetic neuropathy.
- Do not use cold therapy over the side or front of your neck or over your left shoulder if you have a heart condition.
- If in doubt or your condition is worsening then always seek professional medical opinion.
You are in the garden and slip backwards. You feel a twisting type sensation to your ankle. What do you use?
Ice. You’ve sprained your ankle and the sooner you apply ice the less pain and swelling you will get.
After a long day of decorating which involved lots of overhead painting, your shoulder which has an old rugby injury, feels stiff and achy. What do you use?
Heat. This will help relax the muscles you’ve stirred up.
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