Injuries: To Ice or To Heat?

We all know how important it is to maintain an active lifestyle. It’s also important to know how to treat injuries, both acute and chronic, that may occur as a result of activity and exercise. Common treatments for injuries involve the application of ice or heat, but do you know which type of injuries call for which treatment? And do you know the safest and most effective way to apply these treatments? Patrick F. Leary, D.O.FAOASM, an osteopathic sports medicine physician from Erie, Pa., provides the following guidelines for determining when and how to use ice and heat to treat your injuries, and when using the wrong treatment can do more harm than good.

Whether they run a 10k race or shovel snow, it is common for people to experience pain or swelling in parts of their body after an activity or exercise. According to Dr. Leary, there are two types of activity-related injuries: acute and chronic. “Acute injuries are sudden, sharp, traumatic injuries that occur immediately, or within hours, and cause pain. They are typically a result of an impact or trauma such as a fall, sprain, or collision.” Because of this, the cause of the injury is usually obvious. Common signs and symptoms of acute injury are pain, tenderness, redness, skin that is warm to the touch, swelling and inflammation.

Chronic injuries, on the other hand, can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. “Chronic injuries are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn't heal,” Dr. Leary says. “Too much, too soon, too fast, too hard, too often”

Pain and swelling occur because of a few factors. “Immediately after an injury, fibers of the affected muscle, tendon, and/or ligament are disrupted and tiny blood vessels (capillaries) that normally supply blood and oxygen to these tissues are broken,” says Dr. Leary. “The broken capillaries then leak varying amounts of blood and serum into the adjacent tissues. This leakage causes the localized swelling.” Pain and tenderness of the affected tissues occur because of the direct trauma of the injury and the indirect subsequent swelling.

Ice treatments are most commonly used for acute injuries, but can be used to treat chronic conditions as well. “Because the swelling and inflammation that follows an injury is due to the leakage of blood from the ruptured capillaries, cold applications with ice can help by causing the blood vessels to constrict (clamp down).” This constriction of the blood vessels prevents further leakage of blood and serum and minimizes swelling and pain.

Cold therapy is also helpful in treating some chronic pain. A person who has chronic elbow pain that increases after playing tennis may want to ice the injured area after each tennis session to reduce or prevent inflammation. “It's not helpful to ice a chronic injury before exercise,” says Dr. Leary.

In fact, according to Dr. Leary, the optimal management of an acute injury can easily be remembered using the acronym, RICE:

* Relative Rest (minimize movement of the injured body part)
* Ice (apply a cold pack)
* Compression (a light pressure wrap applied to the affected body part can help minimize leakage of blood and swelling)
* Elevation (raise the body part up so that the pressure from the blood and tissue swelling the affected area is reduced as the fluids drain from the area by gravity)

Applying heat to an acute injury does not work and can, in fact, have adverse effects. “Heat causes the capillaries to widen, which leads to an increase in the leakage of blood and adds to the swelling and pain,” warns Dr. Leary. Cold therapy with ice is the best immediate treatment for acute injuries because it reduces swelling and pain.

Heat is generally used for chronic injuries or injuries that have no inflammation or swelling. “Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy,” says Dr. Leary.

Tight muscles are prone to injury. “Heat relaxes the muscles so that workouts can occur as safely as possible. This is also why stretching before and after exercise is important in preventing injury,” he adds.

For those with a chronic condition, it is important to use heat therapy before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow. “Don't apply heat after exercise,” advises Dr. Leary. “After a workout, ice is the better choice for a chronic injury.”

So, what is the best way to apply these treatments? Dr. Leary recommends the following six steps for applying ice to an injury.

1. Apply ice to the injury as soon as possible.
Icing is most effective in the immediate period following an injury. After 48 hours, the effect of icing diminishes significantly.

2. Perform an "ice massage."
Apply ice directly to the injury. Move the ice frequently, not allowing it to sit in one spot.

3. Elevate the body part.
Keep the injured body part elevated above the heart while icing -- this will further help reduce swelling.

4. Watch the clock.
Ice for 15-20 minutes, but never longer. You can cause further damage to the tissues, including frostbite, by icing for too long.

5. Allow time between treatments.
Allow area to warm for at least 45 minutes or an hour before beginning the icing routine again. If the skin is bright pink, it is not ready for another icing.

6. Repeat as desired.
Ice as frequently as you wish, so long as the area is warm to touch and has normal sensation before repeating. However, if pain persists after 48 hours, or gets worse, be sure to see your doctor.

Ice packs can be made from ice cubes in a plastic bag or a warm, moist towel. When using ice in a bag, it’s best to use ice chips so the ice can form around the affected body part. Adding water to the bag also helps. Another option is frozen vegetables, such as peas. These mould nicely and can go in and out of the freezer. Cold packs can also be bought from pharmacies. “Take care when using ice and cold packs from a deep freeze,” Dr. Leary warns. “These are very cold and can cause ice burns quickly if used without care and proper protection.” To protect your skin, you can apply a moist towel or oil.

For treating an injury with heat, remember not to use it to treat a new injury. It will increase bleeding and make the problem worse. When an injury is older than 48 hours, heat can be applied in the form of heat pads, deep heat cream, hot water bottles or heat lamps. “Heat causes the blood vessels to dilate (open wide) which brings more blood into the area,” says Dr. Leary. “It also has a direct soothing effect and helps to relieve pain and spasm.”

When using heat treatments, be very careful to only use a moderate heat for a limited time to avoid burns. “Never leave heating pads or towels on for extended periods of time, or while sleeping,” Dr. Leary adds.

Knowing which treatment to apply, hot or cold, can save a person from a lot of discomfort. However, if your injury does not improve (or gets worse) within 48 hours, be sure to see your doctor immediately.

Preventive medicine is just one aspect of care osteopathic physicians (D.O.s) provide. Osteopathic physicians are fully licensed to prescribe medicine and practice in all specialty areas including surgery. D.O.s are trained to consider the health of the whole person and use their hands to help diagnose and treat their patients.

July 8, 2008
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