When to ice and when to heat

This is a very common question I get asked by people with injuries - when should you apply ice and when should you apply heat to an injury? To answer this you need to understand the difference between acute and chronic pain and injury.

Acute Injuries

An acute pain is characterised by its sudden onset. There is often immediate pain which is as a result of a sudden traumatic incident or impact. The symptoms of an acute injury include pain, heat and swelling

http://www.footymatters.com/

Chronic Injuries

A chronic pain is often of gradual onset. There is often no specific incident which triggered the symptoms. Symptoms may be low grade and mild initially and progress to being long lasting and persistent. Overuse injuries such as shin splints are also classed as chronic injuries.

www.nhs.co.uk

There are different views on when an injury becomes chronic, but generally if symptoms persist for more than 6 weeks an injury is then classed as chronic.

Back to the original question

Now we know the difference between acute and chronic injuries we can look at when to use ice and heat. In future blogs I will go into each of these modalities and their physiological effects in more detail, the purpose of this blog is to set out some guidance that you can use when you get injured. 

Icing an injury reduces inflammation and pain as a result of vasoconstriction. Heat on the other hand relaxes tight muscles and causes vasodilation which aids the removal of waste products from the area. With this in mind the general rule is to apply ice to acute injuries and heat to chronic injuries. If you have a chronic injury heat will help ease the long term symptoms but if you exercise or aggravate the injury thus causing acute symptoms then ice is used during this time. 

Below is a table to help guide you as to when and how to apply ice and heat.

	ICE	HEAT
When	Acute injury such as sprained ankle, hamstring strain. Impact injury such as being hit with a hockey ball. When a chronic injury is irritated and become inflamed	Chronic pain or injury where there is no swelling or inflammation such as stiff/achy lower back, tight muscles.
How	There are many ice packs and gel packs available. Ice packs that are soft are better, if using ice cube crush first. Frozen peas are perfect as they mould to the area of the body. Protect skin by using a damp cloth in between ice and skin. When applying ice using the R.I.C.E (rest, ice, compression, elevation) is recommended.	Heat can be applied in many ways. There are packs that can be microwaved or there is the classic hot water bottle. Another option is bathing in a warm bath or applying a warm compress. If using a heat pack use a damp cloth in between the pack and the skin.
How long	Apply ice for 10-15 minutes depending on the size of the area and repeat every 2-3 hours.	Apply heat for 10-20 minutes depending on the size of the area and repeat every 2-3 hours.

Safety precautions

• Never apply heat/ice for long periods of time or when sleeping
• Never apply ice directly to the skin as this may cause ice burns
• Don't apply ice/heat to broken or irratated skin
• Seek medical advice if you have circulatory problems or diabetes
• Seek medical advice if symptoms persist

Subscribe to my blog for future posts on the physiological effects of ice and heat application and more details on different application techniques.