How often are you presented with a spouse, athlete or little one, shoving a bruised, achy, banged up or stiff – “insert random unexplainable injury here” – and you are just not sure what to do? Should you throw a bag of peas on it? (No, find out why be reading on!) Or a heating pad? Sometimes you might not be sure.
I am here to clear all of this up for you. After reading this short (ish) article, you will be decisive in your actions regarding when to use ice therapy and when to use heat therapy.
This is a really long article! Want to just watch the video? Here you go!
IF YOU ARE MORE OF A READER, ARTICLE CONTINUES HERE
EVERYTHING YOU NEED TO KNOW ABOUT ICE THERAPY
Well, it’s cold, we know that, and it tastes excellent in an adult beverage, but what you might not know are all the benefits of ice when used therapeutically.
We have all seen some coach run for an ice pack enough to know that it is like the universal treatment for everything. (Think Windex – My Big Fat Greek Wedding.) There is some truth to ice application having tremendous healing properties.
The first thing you need to know is that ice is a MUSCLE RELAXOR, a PAIN RELIEVER, and a VASOCONSTRICTOR. This is going to become important when we compare ice to heat (that is why I wrote all that in capitals!)
You also need to know that there are several ways to apply ice. You can buy the gel packs of ice that are flexible and reusable and mold very nicely to the skin. You can also use direct ice by freezing water in a small cup. And finally, you can perform ice emersion of a limb or even your whole body if you are brave! See benefits of cold dunks HERE.
BASIC TIMING RULES FOR ICE
ICE PACKS – 20-30 minutes
DIRECT ICE – 10 minutes
ICE BATH – 10 minutes
There are rules to follow when applying ice in any format. The biggest risk with using ice as a therapy is the potential of frostbite. Yes! You can frostbite yourself with an ice pack. I have seen it many times in practice, and the result is a brown mottled appearance of the frost-bitten skin, and sadly those markings are often permanent.
Parameters to follow when using Ice Therapy.
- Limit your icing to the recommended time listed above.
- If performing repetitive ice treatments, allow the cooled tissue to completely re-warm to room temperature before reapplying the ice a second time.
- Always use some barrier between you and the ice such as a paper towel or thin dishtowel. (Except with direct ice or ice baths.)
When you ice any area, you should know that the cooling process goes through several phases. First, the tissue gets cool, then a little “burny,” then there is pain, and then the numbness sets in. Many people pull the ice off when it gets painful thinking it is too uncomfortable. Know that these three initial phases only take about 4-6 minutes to go through. Once you are at the numbness phase, the process of icing becomes quite comfortable.
Phases of therapeutic cold application
- DO not cover your ice pack with a thick dishtowel or cloth. It will prevent the ice from cooling the tissues enough for the therapeutic benefit.
- Do not use frozen vegetables as an ice pack. They do not get the tissue cool enough because they start to warm up too quickly.
- Keep the ice pack in one area for the duration. Moving the ice pack only allows the therapy to work in an area for a few minutes at a time. To get the full benefit of icing you need the tissues to get numb for at least 15 minutes.
- Some people are allergic to cold! If the ice is just too uncomfortable or you notice that the skin produces hives or raised redness around the area being ice this person may be suffering a cold allergy. Remove the ice immediately. It is best to apply a different type of therapy for this person!
- Again, be sure to allow the tissue to re-warm to room temperature before re-applying ice! (You can subject yourself to frostbite if you don’t follow this rule!)
- Do not keep your ice pack in the fridge. It is to be kept in the freezer otherwise it will not be cool enough to get the tissue to the numb phase. A refrigerated ice pack will simply cool the tissue and not provide the anti-inflammatory benefit for which ice is best known.
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Something else to think about: I had an instructor for my Certified Chiropractic Wellness Practitioner program who made a big case regarding icing. He declared (rather loudly) that the body is a wonderful healing machine and that inflammation is the body’s way of delivering healing factors to a wound. That natural response also provides cushioning to protect the area from further injury. He said DO NOT use ice and let the body’s miraculous healing ability take care of it. I could not agree more. BUTTTTT herein lies the problem. Unfortunately, most of us are walking around in a pro-inflammatory state. Why, you might inquire? Stress, lack of sleep, poor diet, dehydration and exposure to chemicals internally and externally can knock us into a constant pro-inflammatory state. This means instead of a nice leisurely inflammatory response, your body WAY overdoes it dumping copious inflammation all over everything. This is where the ice comes in. If you are a fit, unstressed, perfect diet, zen kinda person, by all means, forgo the ice. If you are like everyone else, ice can be a savior.
EVERYTHING YOU NEED TO KNOW ABOUT HEAT THERAPY
First of all, who doesn’t like heating better than icing? It is what I lean toward but there are reasons to do one over the other, and we will get to that. First, you need to know the “all you need to know” about heat application.
Heat is a MUSCLE RELAXOR, PAIN RELIEVER, and VASODILATOR. Remember above what I said about ice? Ice is also a pain reliever and muscle relaxer, but it is a vasoconstrictor. We are going to learn why this is important in just a minute.
Heat can come in several forms. An electric heating pad, a hot water bottle, a hot compress, infrared heat, ultrasound and a hot bath or shower.
Side note: One of the best ways to heat is with damp heat. Damp heat goes deeper than dry heat and therefore can be more therapeutically beneficial. To create damp heat at home, simply heat up a hot water bottle and wrap it with a damp towel. (Do not use a damp towel around a heating pad!)
When applying Heat, you should also keep your treatment time to 20-30 minutes. More heat can create an issue with drawing more inflammation into the area because of heat’s vasodilative properties. I had several elderly patients who loved to sleep with their heating pads on their backs. They could not understand why they kept waking up with low back pain. Prolonged heating of an area can exacerbate inflammation in the area and cause bigger issues!
WHEN DO I USE HEAT? WHEN DO I USE ICE?
Yes, the question of the day. Well, here it is. Do you remember when I said that heat and ice have similar healing properties (Capital letters)
ICE: Muscle relaxer, pain reliever, and vasoconstrictor
HEAT: Muscle relaxer, pain reliever, and vasodilator
“Jerry is a skier. He is on a ski trip with his buddies and as buddies do he was showing off. He wiped out and hurt his back. Jerry decided that the best therapy for his pain was to sit in a hot tub for two hours and pound Bloody Mary’s. The next morning Jerry was taken by his buddies to the hospital because he could not get out of bed. Yesterday, Jerry suffered an injury that had an immediate inflammatory response. He then increased the inflammation by vasodilating the tissues with heat and alcohol. This caused Jerry’s problem to be far worse than if he had put an ice pack on it three times over the course of the evening and stayed away from the hot tub and the drinks!” – (Storytime over. Back to my point.)
SO, my advice is when in doubt use ice. If you stick to the parameters of icing for the appropriate amount of time and let the tissue re-warm before reapplying, there is little to no risk. Heat, however, does carry the risk of increasing inflammation in an area, and this can create exacerbated issues.
A word on contrast therapy. This is one of my favorite ways to apply temperature therapy. As a kid, we owned a ski condo. It was the seventies, so of course, just off the “rumpus room” there was a ginormous sauna. After skiing all the adults and kids would pile in and spend about 20 minutes heating up. When it got too hot, we would all run outside and roll in the snow amongst a lot of “bellering” and hollering. Then it was back to the sauna for another twenty minutes. The adults swore this process warded off any next day soreness from skiing. They were right. What were unknowingly doing was called “contrast therapy.” We were applying alternating heat and cold therapy to create a therapeutic pump to get rid of metabolites, lactic acid, and inflammation. Contrast therapy is a VERY effective method in dealing with subacute injuries like sprains and strains. Read more about contrast therapy HERE.
Please know that this article comes from 20 years of clinical practice experience. However, other types of clinicians may have differing views. Your acupuncturist is going to want to throw your ice pack out the window, and your ER room doc will tell you ice is only good for the first 72 hours of an injury. I am happy to go toe to toe with any of them on this subject. But make sure to do your independent research so you can make the best decisions when utilizing ice or heat therapy for you and your family.
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