rICE vs Heat
Within the first minutes of injury, if no bleeding or obvious deformity is present ICE may be applied as an analgesic (pain killer), and to aid in the prevention of excessive swelling. Heat is NOT indicated within at least the first 48-72 hours of an injury because it may cause swelling to worsen. For example, with an ankle sprain ice should be applied immediately and the limb should be elevated as to decrease further swelling and pain. “Because cold lowers the metabolic rate and produces vasoconstriction, swelling will be reduced, but does NOT reduce any swelling that is already present” (Knight, K Cryotherapy in sport injury management, Champaign, Ill, 1995 Human Kinetics.) When cold is applied you will feel a ‘stinging’ sensation for about three minutes, it will then turn to an aching feeling for about 2-7 mins., and then will be numb around 4-8 minutes. (Once the ice is on, keep it on and do not take it off because it will just restart the stinging sensation all over again). Ice can safely be applied directly to the skin for durations up to forty-five minutes depending on the tissue type (you should ice a thick muscle longer than an ankle, for deeper penetration). Commercial ice packs are good in situations where regular frozen water is not available. CAUTION: commercial ice packs NEED to be wrapped in a paper towel or other form of barrier and should NOT be placed directly on the skin! IF with ice, or a commercial ice pack the ‘burning/stinging sensation’ does not dissipate in the above times listed and/or the skin becomes raised, itchy, or hot REMOVE the ice immediately as you are probably experiencing an ice allergy. If this occurs and does not resolve within a reasonable period of time, call 9-1-1, or contact your physician immediately.
Heat (moist hot packs, or heating pads) may be applied in CHRONIC, non-acute type injuries (maybe to loosen your back up in the morning). It may be used to aid in increasing flexibility, decreasing muscle spasm, and decreasing joint stiffness. Bear in mind that a heating pad or hot pack SHOULD NOT be applied directly to the skin, and layers should be added as necessary in an attempt to NOT burn yourself! Also, as stated earlier heat will INCREASE SWELLING so it should NOT be used in ANY acute (within the first ~48-72 hours) injury. Moreover, heat should NOT be applied when there is a loss of sensation, directly over the eyes or genitals, or over the abdomen during pregnancy.
Compression is actually the best form of ‘swelling prevention’, as ice is more of a ‘pain killer’. Clinically, compression works best for us because it is something that we can perform 24 hours a day, unlike the rest, ice, and elevation. An ace wrap or other compressive device should be applied by a medical professional, usually from the distal (furthest) to proximal (closest) points of the injury. Ie: for an ankle sprain, the compressive device should be applied from the toes up to the calf, and NOT from the calf down as this will push the swelling into the toes. Also, the wrap should be tighter distally and looser proximally.