Knowing When to Ice or Heat an Injury

As an orthopaedic surgeon and sports medicine specialist, one of the questions I get asked the most is, “Should I use heat or ice to treat an injury?”

With the warm weather drawing bicyclists, runners and walkers outdoors, now is a good time to set the record straight. Understanding how heat and ice works on the body may serve as a useful guide as to which to use.

Ice is a potent vasoconstrictor. This means the blood vessels shrink in size and less blood flow reaches the injured area. Some studies have shown ice to be as effective as post-surgical medications for pain control. It should be used if the area is swollen or bruised. In the case of a joint injury, initially applying ice always is the answer. The initial swelling around joints related to an injury of our ligaments, tendons, and/or cartilage not only hurts, but prolongs our feeling of stiffness and alters our gait. The ultimate time to return to full sport activity, therefore, will indirectly be related to the initial swelling.

When it comes to icing, it’s good to remember the helpful acronym R.I.C.E. – rest, ice, compression and elevation. Stop doing activities that are causing you pain; ice in intervals of 10 to 20 minutes at least three times per day; wrap the injured area with an elastic bandage – tight but not too tight; and elevate whenever you can. Try this for two to three days after an injury – if you don’t notice an improvement, see a doctor as soon as you can. In cases where your knee or ankle immediately balloons up, seek orthopaedic attention.

Heat serves as a muscle relaxer. Heat vasodilates, or opens blood vessels in our muscles and soft tissues.  The increased blood flow seems to promote a healing response. It can reduce tightness and help quell spasms and soreness while carrying oxygen and nutrients to the injury. Heat, unlike ice, isn’t so cut and dry. Muscles are a different beast than joints, and there is less of a one-size-fits-all solution, particularly when it comes to necks and backs. Heat will generally penetrate to the deep muscles better than ice, but sometimes ice will also be beneficial for strains, sprains and tweaks. The presence of substantial bruising in a fresh muscle injury may indicate an active bleed, and in this scenario it is helpful to initially ice to minimize the amount of bleeding in the injured area.

Similar to icing, heating should be done in intervals of 10 to 20 minutes at least three times per day. This typically is done for two to three days following a mild muscle injury. As the injury feels better, it often is helpful to apply heat to the area before stretching. If the injury persists, please seek medical care immediately.

No study conclusively has shown superiority of ice versus heat. If you seek medical attention remember to ask your doctor which modality applies best to your injury. It’s important to listen to your body both during and after application of ice and/or heat. No one knows what is helping and what is potentially hurting better than you.

 

Bradley Dunlap, MD, an orthopaedic surgeon specializing in sports medicine at NorthShore Orthopaedic Institute , has been treating elite-level hockey players since 2009. He has worked with USA Hockey as a team physician during tournaments in the United States and Europe. He also serves as a team physician with Evanston Township High School.  As a former college hockey player, his own personal athletic experience provides insight into the way athletes think, both in injury and health.