When to Apply Hot or Cold Therapy to an Injury

Hot and cold therapy treatments are extensively used, therapeutic modalities for treating and rehabilitating sports injuries. There is, however, often confusion following an injury concerning whether to ice or to warm the area. The answer depends on the type of injury you have sustained.

Acute Injuries

Acute injuries are those which result from traumatic incidents (a fall, twisting movement or direct blow for example) and are immediately painful. When an acute injury first occurs, bleeding, inflammation, swelling and pain must all be controlled.

Cold therapy or cryotherapy is the best immediate treatment for acute injuries, and should be applied as soon as possible, for up to 20 minutes at a time and be re-applied regularly, in order to:

• Provide pain relief
• Reduce bleeding and swelling - ice causes the narrowing of blood vessels, a process known as vasoconstriction
• Decrease metabolic rate – reducing the risk of cell death
• Reduce muscle spasm

Following approximately the first 3-5 days of an acute injury, once bleeding has stopped and there are no signs of swelling, you may wish to alternate cold and heat treatments. Apply cold for 10 minutes, followed immediately by 10 minutes of heat. Doing this causes massive increases in blood flow to the area as the vasoconstriction caused by cooling reverses when heat is applied, resulting in an influx of blood to the damaged tissues, aiding the repair. Ensure all bleeding has stopped before applying this technique.

Chronic Injuries

Chronic injuries usually do not present with a sudden onset. Often caused by overuse or biomechanical abnormality, they tend to gradually build up over a period of days, weeks or longer. A chronic injury can also be caused by an acute injury which fails to heal due to a lack of, or inappropriate treatment.

Heat therapy is generally used for chronic injuries or injuries that have no inflammation or swelling. Heat should be applied for 15-20 minutes in the form of hot water bottles, a warm damp towel, heat rub or commercially available heat pads. If using something such as a hot water bottle, ensure a suitable layer of protection is placed over the skin to prevent burns.

Applying heat therapy helps to relax tight, aching muscles and joints, increase elasticity of ligaments and tendons and increase the blood flow to the area. Using heat therapy on chronic injuries prior to exercise is very helpful as it warms the muscles and increases flexibility.

The only time ice should be used on chronic injuries is after exercise, to reduce any residual swelling.

When not to Ice

In some instances the use of cryotherapy is inadvisable, people with the following conditions or circumstances should not be treated with cold:

• Circulation problems - such as Raynauds Phenomenon.
• Cold hypersensitivity - some individuals may develop rashes or blistering.
• Anesthesia - when there is an area or numbness or altered sensitivity, as patient can not feel pain or degree of cooling.

The following conditions need extra care taken when applying cold to an injury:

• Cardiac Conditions - such as Arthymia, Angina or CHD
• High Blood Pressure - Vasoconstriction could serve to increase blood pressure
• Superficial Nerves - Cryotherapy should not be used on an area where nerves pass close to the surface
• Healing Wounds - Cold therapy should not be used over a new wound

Reference:

www.sportsinjuryclinic.net

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