One of the most common questions a PT gets is “Should I use Heat or Ice?” It all depends on the nature of the injury.
Acute Injuries
Within the first three days after an acute injury (think sprained ankle, knee pain) or 72 hours ice should be applied to the injured area. With an acute injury, extra heat can increase inflammation and delay healing. With an acute injury, the cold constricts blood vessels which helps numb pain, relieve inflammation, and reduce swelling and bruising. Early on heat may make an acute injury worse and limit healing. Below are some examples of reusable ice packs that can be used. Apply the ice pack to the affected area for 20 minutes. Make sure there is a towel barrier between skin and ice pack. Elevated the injured area above your heart level will also help reduce swelling in the area.
Injuires > 6 weeks old
Heat may be used in injuries greater than 6 weeks old. Heat helps increase blood flow to the area, relaxes tight muscles and relieves achy joints. Heat is helpful to improve range of motion in a joint that may be tight or where the motion is restricted. Using heat before stretching may be helpful and help elongate the muscle. Heat may be applied to the affected are for 20 minutes prior to exercise. May sure to have a barrier between the heating pad and your skin. Moist heat is more effective as it has been shown clinically to penetrate deep tissue faster than dry heat. It is also better for your skin.
Above are three examples of moist heating pads that can be use at home.
Ice may be used after exercise to prevent flare up or inflammation. A good rule of thumb is “warm up, cool down.”
Arthritis
Inflammation in a joint caused by worn-away cartilage and arthritis can cause pain,inflammation and stiffness in places like your knee, wrist, elbow, fingers and shoulders. Moist heat is preferred for these conditions. Soaking in a tub or shower with warm but not hot water is recommended (temp 92-100 degrees.)
Gout
Gout is a disease in which defective metabolism of uric acid causes arthritis. A gout flare-up is one arthritic condition that ice would be more effective. Ice will calm the pain and inflammation caused by a gout flare-up and numb the pain.
Muscle Sprain and Strain
Muscle strains and or sprains will benefit from a combination of ice and heat. When a pulled muscle or sprained ankle/joint occurs it is better to start off with ice for the first 72 hours to reduce accompanied swelling, pain and inflammation. After the inflammation has resolved, heat may be effective to relieve the soreness and stiffness at the injured joint or muscle.
Tendinitis/Tendinosis
Tendinitis is painful inflammation that affects the tendon, which is the connective tissue at the end of the muscle that attaches the muscle to the bone. These injuries are usually caused by overuse and repetitive activities at a joint. Common sites for tendinitis are your elbow (tennis elbow), knee, shoulder and Achilles tendon. Ice is the preferred treatment for the first 72 hours to relieve the pain and reduce inflammation. After the inflammation subsides, heat will be effective to reduce stiffness and relax the muscles to help improve flexibility and stiffness at the joint that usually occur as a result of the overuse injury.
Tendinosis is a chronic, long-term condition caused by repeated tendinitis and degeneration of the tendon. Heat is best for relieving the stiffness accompanying this condition.
If you have sustained any of the injuries mentioned above, a Physical therapist can help guide you through the healing process. Give us a call 843-637-0225!