Ice or Heat – which one should I use

This is a question I get asked at least 2 times every day. ” Doctor, I hurt myself doing something this morning should I put ice or heat on it to relieve the pain? ”

There is always swelling and pain with an injury, even more so with soft tissue injuries. Injury causes bleeding which causes swelling. The swelling causes pain and impaired healing. The swelling also puts pressure on the adjacent tissues which also causes pain and impaired healing.

First and foremost an assessment must be made to determine the extent of the injury and decide if you need to see someone for care of if it can be handled at home or on the site.

When soft tissue injuries occur, the first priority is to attempt to stop the bleeding since this results in swelling and further pain. USE COLD, COMPRESSION AND ELEVATION. The cold can be used for the first 24 to 48 hours off and on. A general rule of thumb is 10 to 20 minutes on then 40 to 60 minutes off. This can be repeated for 6 to 8 times in a day to control the swelling and pain. It is not helping the healing process, in and of itself, other than it will, in the end, allow for shorter recovery time. The goal is to reduce swelling by reducing the blood flow to the area. Pain reduction is accomplished by decreasing nerve signals.

Urgent conditions require medical attention and should not be ignored. If any of the following is present see a doctor. Loss of consciousness, persistent headache, nausea, vomiting, dizziness after a head injury. Pain in spinal areas after impact. Abdominal pain, blood in the urine, suspected fracture, dislocation, eye injury, or a deep wound with visible bleeding, Any breathing difficulties or significant bleeding will always require attention and medical care.

If all is going well in 24 to 48 hours then begin warming with heat treatment. Heat should not be used for at least 48 hours after the injury has occurred. Heat will increase the blood flow and assist in healing but it is necessary to assure that further bleeding will not occur by dilating the blood vessel with heat. NO HEAT FOR 48 HOURS.

Heat will help after the acute inflammatory stage has ended. It increases circulation and cellular metabolism, decreases muscle spasm and has an analgesic effect on the surrounding tissues. Use it for up to 20 minutes then discontinue to allow blood flow to normalize. Do not apply again for one hour and move the tissue with activity or gentle massage depending on tolerance before heating again. If pain results from heating go back to the ice stage for another day.

Continue with compression and gently re-establish movement. If problems still persist, have the injury evaluated.


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