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How do you know when to ice or heat an injury?

Applying intense heat or something cold to an injury is a popular treatment, either as a result of medical advice or simply because it is thought to help. From DIY versions such as a frozen peas and hot flannels to specially purchased cool packs and instant heat pads, this is definitely a popular self-treating remedy which promises to offer relief from symptoms such as pain and swelling.

While there’s little doubt that both heat and ice help relieve many kinds of injuries, there are some important points to consider before adopting either method into a treatment plan. In particular, it’s important to be aware of the impact of both on human physiology in order to correctly identify which approach will be most beneficial for the injury concerned.

The basic rule of thumb is to use heat for long-standing muscle aches/issues and ice for immediate joint or muscle damage and pain, but both need a more thorough explanation so it is clear where either approach can both help and hinder.

The Case for Heat

Heat is most commonly used to deal with chronic - or long-established - muscle problems such as stiffness, pain or spasms. It works effectively because when muscles are damaged, raising the temperature of the injured area is crucial to bring relief. As heat boosts the blood flow in the surface it’s applied to, it tends to help relax the muscles involved and reduce the pain experienced, which in turn helps to repair the damaged tissue.

Heat is also comforting for the mind too, and as tension and stress are often contributory factors in this kind of pain scenario, the benefits of heat treatments can help soothe and eliminate the root problem.

Most heat treatments can be used for lengthy periods at one time without any problems or issues, providing longer-term comfort beyond the primary pain relief experienced. Milder cases of muscle stiffness and pain generally ease within 15 to 20 minutes of heat therapy being applied, while more severe cases usually experience the full benefit within an hour or two.

Dry or Wet Heat?

Neither has any particular clinical advantage, so it really comes down to which is best suited to treat the injury in question. For example, conducted heat therapy, often referred to as ‘dry’ heat and most often seen used in heating pads and packs, is fast-acting and easy to use for most people. A hot water bottle can provide an effective DIY source of relief for a small or isolated area of pain. Wet, or ‘convection’, heat which uses warm wet cloths or warm water, for example, is possibly easier to arrange and more suitable when a larger area of the body is injured. Soaking in a warm bath is something many people find useful when experiencing general muscle fatigue post-exercise or exertion.

Warning Flags

Heat therapy in any form is not suitable for: open wounds, swollen and/or bruised areas, people with medical conditions such as diabetes, DVT, multiple sclerosis, vascular and some skin diseases. Those with high blood pressure, a history of heart disease any other recognized medical condition or who are pregnant should seek medical advice before applying these treatments at home. As it tends to aggravate any inflammation, it is never a good choice for acute injuries.

When Ice Is Nice

Fresh or acute injuries such as a twisted ankle often respond better to cold-orientated treatments, as the ice element helps to combat the immediate tissue inflammation and swelling. It’s generally seen as a short-term emergency response rather than something to use for extended or long term periods.

How Cold Helps

By reducing the blood flow to the injured area, the ice allows the inflamed and swollen tissue to settle down a bit, and it can also help reduce the consequent nerve pain often experienced. Pulled muscles are mostly managed very effectively by ice therapy, providing it is used when the injury is very fresh.

Application Options

Many people choose to use something from the freezer, although specially designed ice packs or frozen gel options are readily available in pharmacies and online, as are aerosols of cooling sprays, and of course don’t forget good old ice cubes - sometimes delivered in a bath or bowl of water.

Cooled or frozen items of any kind must never be applied directly to an injury or the skin or used for prolonged periods of time. Wrap packs well in a towel and use them to treat the injured area for around 10-15 minutes a time, several times a day, until the acute phase is passed.

Ice Warnings

It’s easy to damage yourself with ice treatments, and consequently along with the general usage advice there are further restrictions on who can use this option. It’s a no-no for anyone with diabetes, Reynaud’s or any kind of sensory or circulation disorder which impairs the ability to detect unusual heat or cold in the extremities.

The Verdict

Self-diagnosing and treating minor injuries isn’t unusual in this digital age of Dr. Google, and both heat and cold therapies can be a cheap and effective way of reducing pain and trauma caused by injury when used correctly. However, as misunderstanding how to use heat and ice can be damaging, it’s vital to keep in mind what each is designed to do and how best for that to be harnessed to deliver pain relief rather than further trauma.