HEAT vs. ICE

ScottyDoc

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HEAT vs. ICE

Ice packs and heat pads are among the most commonly used treatments in orthopedics. So which one is the right one to use for your injury, ice or heat? And how long should the ice or heat treatments last?

HEAT: Heat treatments should be used for chronic conditions to help relax and loosen tissues, and to stimulate blood flow to the area. Use heat treatments for chronic conditions, such as over-use injuries, before participating in activities. Do not use heat treatments after activity, and do not use heat after an acute injury. Heating tissues can be accomplished using a heating pad, or even a hot, wet towel. When using heat treatments, be very careful to use a moderate heat for a limited time to avoid burns (20 minutes). Never leave heating pads or towels on for extended periods of time, or while sleeping.
ICE:
Ice treatment is most commonly used for acute injuries. If you have a recent injury (within the last 48-72 hours) where swelling is a problem, you should be using ice treatment. Ice packs can help minimize swelling around the injury. Ice packs are often used after injuries, such as when a sprain/strain has occurred. Applying ice early and often (20 minutes per treatment) for the first 48-72 hours will help minimize swelling which will, in turn, help to control the pain. Ice treatments may also be used for chronic conditions, such as over-use injuries. In this case, ice the injured area after activity to help control inflammation. Never ice a chronic injury before activity (heat is protocol for that).

Application of HEAT & ICE: Application of either ice or heat should never be longer than 20 minutes to reduce risk of burning skin, as the skin can be burned/damaged from both ice and heat therapies if used improperly. Also, direct heat or cold should never be applied directly to the skin, there should always be some form of buffer between the two (towel or cloth). Also, my personal preference (what I recommend to my patients) is once an injury has gone past 72 hours and is considered a chronic injury heat and ice should be applied alternately, always ending in ice. For example, 20 minutes of heat then 20 minutes of ice, one right after the other, always ending with ice. So without getting technical, the way I look at it is the heat speeds things up and allows more blood and lymph flow to the injury, which speeds up the healing process. Ice, however, slows everything down and decreases the amount of blood and lymph in the injured area, but also decreases swelling & inflammation (responsible for pain). So think of it as a pump, heat pumps the good stuff in and ice pumps the bad stuff out before it pools and starts to swell and become inflamed. Also, as mentioned above if it is an over-use injury, heat before activity to loosen/warm muscles up and ice after activity to reduce inflammation/swelling, therefore reducing pain.
 
I always use ice for longer than 20 mins. Especially when icing a nerve injury (ie: sciatic nerve strain) you ice it until the area is numb. It works great for me.
 
I always use ice for longer than 20 mins. Especially when icing a nerve injury (ie: sciatic nerve strain) you ice it until the area is numb. It works great for me.

Lets just go with 20 mins being the standard as to not burn the skin (frost bite). Personally when I ice, it goes numb way before 20 mins?
 
Home Made Ice Pack:

OK, here is a little trick I learned and tried out the other day on how to make a good ice pack at home. I am not trying to take credit for it, I found it on another forum, but it is good and consistent with my HEAT vs. ICE post.

Ingredients:
2 Gallon size ziplock bags
rubbing alcohol
water

Fill one of the ziplock bags 1/2 way with 1/3 rubbing alcohol and 2/3’s water. Freeze and it becomes nice and slushy, won’t freeze solid, so it is excellent for hard to ice areas like shoulders, knees, elbows wrists, etc. It allows you to conform it to the area. I always put the 1st ziplock bag into a second one just to make sure there is no leakage.

Hope this Helps!
 
I'm a therapist and I was specifically taught that ice was useless for deep penetration if it wasn't allowed atleast 20minutes. It makes sense...a thick beefy shoulder will take a while to benefit from ice if there's a tendinitis.

If heat is applied properly, there will be no concern about "burning" the patient. One should always apply enough towel layers to ensure a professional wet hotpack doesnt hurt the patient. And moist heat is what therapists use. It has the most benefit.

Combo of heat and ice: I think a trained professional can decide when to use both. If ice makes the spine tense up and you're trying to treat a new injury there, I personally have used ice on the spine with heat on the muscles to both sides...relaxing, soothing heat while the ice on the trouble spot reduces inflammation. I don't recall learning this in a textbook, but it was common practice in our clinic.
 
Re:

injuries to the musculoskeletal system, including spine and joint injuries or deformities are treated by specialized practices. This is again one o\f the known and best used practice to solve the problems regarding orthopedics. :flipoff:
 
So, I'm a little confuzed. After I get home from the Gym I always put heat on my shoulder because it gets sore. According, to this thats not right and you should only apply heat pre exercise. So should I be using ice instead of heat????
 
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