Ice or Heat For That Injury?

Repeat after me.... I promise, never to pull out the heating pad when I hurt my back/neck/shoulder/knee/ [Insert body part here], etc. And if I should ignore these instructions, I promise not to fall asleep on my heating pad for the whole night long! I also promise to stay out of my neighbors Jacuzzi.

It is really unfortunate that most people still pull out the heating pad whenever they hurt themselves. It's also unfortunate that some health professionals still tell you to use a heating pad. This comes down to a basic lack of understanding of the inflammatory process. When you hurt yourself, you damage tissue. These tissues release chemical substances designed to increase inflammation into the area, they also release chemicals that cause further tissue damage. The use of heat in this stage will not only prolong healing, but also increase tissue destruction. Heat adds fuel to the fire and ice should be the treatment of choice in the vast majority of acute cases.

Indications for use and benefits:

Whenever acute tissue injury/damage occurs ice should be the initial therapy of choice during the first 3-4 days of acute injury. Whenever tissue destruction/injury occurs the body responds by increasing circulation to the area in an attempt to limit motion at that area by increasing swelling, creating a natural splint or cast. The body's reaction to injury is strong. Inflammation actually increases further tissue destruction in the area. The body can overreact to injury and ice is very beneficial in reducing further tissue destruction by decreasing swelling and pain. This increased tissue destruction is unwarranted unless the skin barrier has been broken allowing foreign debris (bacteria) to be introduced in the body, then it would be very important to have this heightened immune response by the body. But most acute muscle strains/ligament sprains are "closed" wounds (skin barrier intact) and ice can be of great benefit. Unfortunately some people still pull out the heating pad for relief which does give soothing relief, but can increase pain afterward. The use of heat in the acute stage will actually prolong healing in comparison to ice.

Types of ice therapy:

  • Ice pack- Consists of ice cubes in a plastic bag. This is the best and most economical therapy you can use, found in almost every home. Less of a danger with frostbite

  • Gel pack- Gelatinous substance in blue plastic bag.(i.e. Blue Ice) Danger of frostbite if used incorrectly. Gel material is freezer temperature (0F)

Application and use:

Ice and gel packs should never be applied directly to the skin. Direct contact with a gel pack (0F) can cause frostbite. Ice packs are usually not as cold as gel packs but you can also get frostbite with them if the ice is cold enough and used for too long. Wrap ice/gel pack in a towel (one layer) and apply to direct skin, the towel provides protection from frostbite. Treatment time is 15 to 20 minutes; never go over 20 minutes! If you go over 20 minutes you could aggravate your condition. If left on too long you could freeze the skin and develop frostbite! If you have not used ice before it is important to know that you will typically go through four stages: You will feel cold obviously, usually followed by a burning ache, then pain followed by numbness at approximately 15-20 minutes. It is very important that you get to the numbness stage, which gives you the best therapeutic effect. Always wait at least 1 hour before reapplying ice to allow the skin to warm back up again to body temperature. This allows for an effective "pumping" action in areas of swelling. Typical frequency for using ice is every other waking hour.

Contraindications to using ice:

Ice should not be used if you have the following conditions:
  • In areas of decreased circulation. i.e. Diabetics, Raynauds disease, old age.
  • Allergic to cold.
  • Metabolic disease. i.e. Gout and other rheumatoid conditions.
  • Previous history of frostbite in the area involved.

Tissues that are damaged heal better and stronger when they are progressed through a treatment protocol that addresses each of the three phases of healing:
  1. The Acute Phase - The first 48-72 hours.
  2. The Repair/Regeneration Phase - 48 hours to six weeks.
  3. The Remodeling/Rehabilitative Phase - Three weeks to 12 months +
Once out of the acute phase other areas need to be addressed such as: Myofascial techniques to reduce scar tissure formation; Strengthening of the injured areas with therapeutic exercises; And joint manipulation to increase range of motion and improve proper joint function. Other therapies such as Electrical Muscle Stimulation, Interferential current, Ultrasound, Myofascial Release/Trigger point Therapy and Proprioceptive Re-education are also utilized in this office to return the patient to pre-injury status. Chiropractic manipulative treatment is essential to restore normal joint function to allow pain free range of motion and smooth coordinated muscle contraction.

Now once again repeat after me.... I promise, not to use my heating pad when I hurt myself. I promise to donate my heating pad to charity.