|Question from: 2/23/98
Question: "I frequently get mixed answers when inquiring about the appropriate use of heat or ice in the treatment of injuries. Please help shed a little light on this subject."
Charles H. Booras, M.D.
Answer: The modalities of hot, cold and compression have a very appropriate role in the treatment of most injuries. The immediate result of almost all injuries involving the soft tissues (muscles tendons and ligaments) includes pain, possible bleeding, and a leakage of fluid from damaged tissues into the area. Afterwards, there is a migration of white blood cells into the region of the injury. For this reason it is common to have inflammation, swelling and stiffness following an injury.
The healing process requires increased blood flow into the area of an injury to support the process of cellular growth. As long as swelling persists and circulation is congested, the healing process is delayed or retarded.
The swelling must be reduced before full recovery can occur.
Cold and compression are medically recommended therapies for the first 72 hours after an injury to help reduce local pain and swelling. More importantly, by containing the severity of swelling, the application of cold and compression can have a significant impact on helping to promote healing and speed recovery from that injury.
Many first-aid authorities recommend the simultaneous use of cold and compression therapy, often identified as R.I.C.E. therapy.
R = Rest. Avoid over-exertion or weight bearing on the injured body part.
I = Ice. Apply cold to the injury as described below.
C = Compression. Apply compression with an elastic bandage.
E = Elevation. Elevate the injured area above the level of the heart (about even with the lower portion of the breast) to help drain the area of excessive fluid accumulation.
Once swelling has subsided (about 2-3 days or so), the application of heat will help reduce pain and promote healing. Heat can be used to provide effective relief from the aches and pain associated with sore muscles and stiff joints.
What follows is further detail about each of these three therapies.
It has been found that cold applications (ice packs, cold compresses, frozen gel packs, frozen bag of peas, etc.) to the surface of the body will cause a contraction of the small blood vessels in that area. This will have an immediate effect on reducing the flow of blood and other fluids through that area, and therefore help to reduce local swelling.
An addition, a cold application will also help relieve any pain in the area by reducing the sensitivity of local nerve endings. The following specific problems respond especially well to cold therapy.
Be careful not to apply an excessively cold product directly to the skin surface. At the very least, place a paper towel on the skin before applying cold and then wrap the cold product in place with an elastic bandage. Leave the cold product in place for approximately 15-25 minutes and elevate the involved joint or limb to about heart level if possible.
Cold therapy can be applied every two hours during the initial 72 hours after an injury. If the injury is somewhat severe, the cold can be applied 2-3 times in a row for 15-20 minutes each with a 30-minute rest between applications. This type of treatment can be repeated several times a day.
When used properly, cold therapy can help reduce the severity of symptoms and the time required for recovery.
Heat Therapy (hot compress, microwaved gel pack, heating pad, etc.) promotes blood flow and enhances healing. Moist heat will penetrate more deeply than dry heat.
To aid recuperation from an injury, heat should only be used after swelling has subsided and after cold therapy has already been used. One should limit the application of heat to no more than 20 to 30 minutes at a time four times daily. Do not fall asleep on a heating pad!
People with nerve or circulatory problems (such as advanced diabetes) should not use heat unless otherwise prescribed by a physician. Do not apply heat to broken and/or sensitive skin. One should not sit, lean or bear weight on the hot compress.
Proper use of heat can