Sometimes it can be difficult to know how to care for an injury.  You might be asking yourself, “Should I use ice or heat?”  It can be especially conflicting in the middle of winter when you feel cold to even think about putting an ice pack on your skin.  Knowing the basics of hot and cold therapy will help you make the right decision.  Read on…

Cold acts as a vasoconstrictor (closes down the blood vessels and decreases swelling) and also acts to dull pain.  Heat acts as a vasodilator (opens up blood vessels and increases blood flow) and can increase the sensation for pain.

So, what happens when you have an injury?  Typically, some of the tissue tears and there is swelling.  When an injury occurs, your body sends special cells to the area to clean up  the injured tissue and then repair what is left.  This activity usually takes place for the first 48 hours after injury and the repair is made of a denser, less flexible tissue (scar tissue). 

There is a fine line between wanting inflammation to start the healing process and needing to get rid of it so the healing process can move on.  In general, you want to use cold therapy in the first 48 hours to control swelling and keep the healing response in control.  After this period of time, you can use heat therapy if it makes you feel more comfortable.  Using heat too early on after injury will increase blood flow and stimulate too much healing response, leading to excess scar tissue production.

Icing can be accomplished in a variety of ways.  You can utilize a bag of frozen peas or corn.  This works well and is fairly easy to mold around an injured area.  When you are through, you can simply place it back in the freezer to use later.  Just don’t plan on eating your ‘ice pack’ when you are finished…you’ll need to throw it away.  You can also use a zip baggie filled with ice cubes or a cold pack you purchase in a store, designed to re-freeze and use over and over.  Whatever you use, you want to place a thin towel or paper towel between the cold and your skin, preferably a wet one.  You can apply the cold for 15-20 minutes, then remove until your skin returns to room temperature and re-apply for a second 15-20 minute cycle.  If you start to feel burning pain, you should remove the ice, even if it hasn’t been on for 15-20 minutes.  You can use this process (2 15-20 minute cycles) two or three times per day.

Another good way to use cold therapy is with ice massage.  To make an ice massage cup, take a paper cup and fill it ½ to 2/3 full of water and place it in the freezer.  Once frozen, peel away enough of the cup so that about 1 inch of ice is exposed.  Hold the cup and turn it over so that the ice is on the skin and move it in a circular motion all around the painful area, massaging the affected area with ice.  Perform the ice massage for a few minutes, and you should notice several phases.  First you should feel cold, then a slight burning and last you should notice a numbness.  Ice massage should only be done for 3-5 minutes.  Once finished, stop the massage and allow your skin to return to room temperature and then repeat a second cycle (no more than twice).

Heat should not be used in the first 48 hours after an injury.  Heat will increase blood flow and inflammation which will increase the healing or scarring response.  After 48 hours, once the initial healing has taken place, it should be safe to use heat therapy and can be beneficial to make some of the initial scarring more flexible.

Heat can be applied by using a commercially available electric heating pad.  Some have an option to create moist heat which tends to penetrate the skin better.  By increasing the blood flow, heat can serve to loosen tissue up prior to stretching and may help with flexibility.  Heat can be applied for 15-20 minutes at which point it should be removed and if a second application is desired, the skin should first be allowed to return to room temperature.