Hardly a week that goes by when someone from the gym or on the sports field asks me, "Should I ice or heat my knee/shoulder/neck/wrist...(fill in the blank)?

There are times when ice is the modality of choice, while other times heat is recommended. Some times the answer is to use whatever gives you the best result and the most relief. If you know what you are trying to accomplish, and why, you can make an informed choice.

Ice treatment, also known as cryotherapy, uses cooling to treat an injury. Ice is primarily used for acute injuries, an injury of severe onset and short in duration.(This would include most surgeries as they are in themselves a trauma to the tissues.)  An acute injury results in damaged tissue and cells that stimulate the release of histamine in the body. The histamine reaction increases the blood supply to the affected area and brings healing nutrients. This flood of blood and nutrients will in turn increase inflammation and bleeding. However, inflammation must be cleared before healing can start. Ice used properly on an acute injury can "jumpstart" the healing process by reducing the amount of inflammation but not stopping it altogether.

Ice works at a cellular level to constrict blood flow. As the body tissue is being cooled, nerve cells cause adjacent blood vessels to constrict, slowing the blood flow to that area. When the ice is removed and the muscle or tissue warms, the blood vessels expand again with new blood coming in and cleaning the debris that was left behind. The length of time to apply ice varies, from 10 - 20 minutes at an application. I instruct my patients as to the duration of cold pack application dependent on the body part that is affected. "Meatier" body parts (buttocks, hamstrings) may need a full 20 minutes of icing. Areas of less dense tissue (elbow, wrist, shin) may only require 10-12 minutes of ice. A general rule is to wait 1 hour between applications, and you can ice as many times as needed in the first 24 hours. Continue icing for 72 hours after an acute injury.

Heat is used primarily for chronic injuries and degenerative changes in the joints. Chronic conditions are defined by slow development over time and persistent and long lasting like the degenerative hip that aches after a day of golf or the aching back after spending all day in the car. Chronic conditions develop ischemia (lack of blood flow) which is detrimental to healing. Heat is used in physical therapy to increase mobility of the joint connective tissues, usually at a joint or muscle where there is little swelling. Ideally, moist heat is the best type of heat for the affected joint. You may apply heat both before and after activity. Apply the heat for 20 minutes, being mindful of how sensitive the skin and tissue is, and the temperature of the heating pad.

There are rare instances when you might utilize ice baths, or ice massage for an injury, or alternate ice and heat. These applications are best discussed with your physical therapist, who can assist you in making the proper choice, and give guidance regarding duration. The simple modality of cold or heat can make any injury less severe and speed your road to recovery!  

Make Your Own Ice Pack                                                

Use 1 part alcohol (anything from rubbing alcohol to vodka!) to 3 parts water. Place in a doubled ziplock bag and freeze for 24 hours. You will have a slushy, form fitting ice pack that you can reuse - without the expense of a fancy store bought pack!