Posted on March 08 2017
When do you use an ice pack and when do you use a heat pack on an injury? Well most agree that heat generally feels better on the surface you may quickly become a fan of the benefits of ice if it suits your physiological make-up. In my 30 plus years of applying these modalities, I have found that it is a combination of science and personal preference.
The use of heat in the rehab setting is typically moist heat, ultra sound, and whirlpools/therapeutic pool. For home use, reusable heat packs are used to relieve stiffness after inflammation resolves. Moist heat can offer relief from chronic irritation and stiffness in tendons (Tendinosis) and arthritic stiffness. Heat should not be used on inflammation or acute injuries as a basic rule.
The use of cold therapy is designed to physiologically block pain. If you are not a big fan of taking pain meds, anti-inflammatories(NSAIDS) and their possible side-effects, then ice is going to be your go to modality. How does ice block pain you ask? Well when a muscle is in its shortened state, it can program a repeating process to influence nerves in the area to continually spasm. These spasms can be painful but eventually broken with the use of cold therapy. We can dive into a complex discussion on the physiological process known as the gate theory of pain here but we’ll save that for another day. In a nutshell, the ice pack application is used to bring the muscle back to a more natural resting state without producing more pain. Arthritic flare ups, headaches, Strains/Sprains, Tendinitis and post op swelling are all good cases to use ice or a reusable cold compression wrap. Not to be left out is the use of ice or an ice pack following a tough workout. Cold therapy can assist in recovery and help prevent the many of the overuse inflammatory injuries that plague elite level athletes and weekend warriors alike. An ounce of prevention can really go a long way for an athlete. Remember that a proper cool-down is just as important as a proper warm-up.
Cold therapy is offered in many forms from ice cubes and cold baths, to reusable ice packs and topical gels. My experience is that if a cold wrap is easy and comfortable for an individual to use then they will actually follow through with the treatment and eventually make a habit of doing it for prevention. The first couple minutes of cold may be tough to swallow for many but once they’ve made it past the initial stage it becomes rather soothing for the remaining duration. The cold does not have to be teeth-chattering and should be applied for no more than 15-20 minutes at a time. Just remember, too much cold can be damaging to the injury and the underlying tissue, so time duration is very important. More time does not equate to more healing. Deeper tissue areas such as the shoulders and hips can handle more cold than hands, feet or the posterior aspect of the knee. Some individuals with neuropathy or Raynaud's can be ultra-sensitive to cold so make sure there is a barrier (paper towel or thin layer of fabric) between the skin and cold treatment. Cold should not sting like pins and needles or increase pain...if it does its time to remove. Cold is generally applied during the first 48-72 hours or until pain has reduced and swelling has subsided.
By Shawn J. Hickling BSc, PTA Shawn received his degree in Exercise Physiology from Chapman University.
He has worked in the field of Sports & Orthopedic Physical Therapy for over 15 years and is the founder of ActiveWrap Inc. 2003-2004 Official Therapy Wrap of USAG and United Spirit Assoc.