A common question I get with regards to injuries is when to apply ice and when to apply heat. There is no simple answer to this question, but rather some general guidelines and strategies which should be followed.
When an injury takes place there is a natural inflammatory process which begins to help repair the tissues involved. Blood is redirected to the area, (swelling) and the body attempts to repair the tissue in a fast and effective manner. The body also attempts to prevent further injury to that area by limiting movement through swelling and tightening of muscles.
Initially following any injury ICE is the preferred treatment choice. The acronym “PRICE” is often used for advice IMMEDIATELY after the injury and for at least 24-48 hours following. It stands for Protect, Rest, Ice, Compress and Elevate. The goal of “PRICE” is to speed up the healing process by shortening the amount of time the athlete spends in this initial inflamed state. Ice application combined with a compression bandage and rest is an excellent way to recover from injury.
Proper ice application is extremely important. Frostbite can result from keeping ice on for too long or applying it directly to the skin. Believe me I have seen this in my practice! Safe ice application would be to apply for 10 minutes, take 10 minutes off and then reapply for 10 minutes on again. This has been proven to keep the area good and cold, while minimizing the risk of frostbite. Gel ice packs or bags of frozen peas are effective, and placing a wet t-shirt or thin cloth between the ice pack and the skin can protect it from sticking.
Once the injury has been iced for an initial 48 hours, heat application MAY be warranted. Because heat brings more blood-flow to the area, if it is applied too early inflammation and swelling may persist thus delaying recovery. Heat should only be applied once the initial swelling and bruising has disappeared. Heat is excellent for preparing the body for movement (as mentioned in our article on proper warm-up) and should be applied prior to exercise, whereas Ice is more effective after activity. Heat is also much better for muscular injuries, with ice being better suited for joints.
After an injury there is always a risk for re-injury. Taking care to properly warm-up the area before exercise and icing using the 10-10-10 protocol following activity can help prevent future injury and assist the continued healing process. Injuries are a part of sport, but with proper addressing of these injuries you can get back to activity quickly and avoid recurrence of injury.
In good health,
Dr. Scott Dunham
