By Dr Livia Chiarelli

One of the most common confusions to face patients is whether they should be icing or heating after an injury.  Ice and heat therapy is one of the most common at home self-care strategies that patients use, however, in order to receive the best benefit from your self-treatment it is good to know which treatment choice to use and when.

In order to decide which option is best for you it is important to understand that injuries fall into two general categories, acute injuries and chronic injuries.  Acute injuries are often a result of a trauma or impact, they are sudden and typically symptoms are short lived.  The most common symptoms involved in an acute injury are pain, swelling, redness, and skin that is warm to the touch.  A common example of an acute injury is a sprained ankle.  Chronic injuries, however, develop slowly and symptoms persist for a longer period of time, they are often a result of overuse and common symptoms include tightness, dull pain or soreness.  Also, acute injuries that aren’t properly treated may become chronic in nature.

Ice is the best protocol for acute injuries because it reduces swelling and pain.  Ice should be used from the time of injury and for the next 72 hours.  Ice is also a good at home treatment method for a chronic injury after each flare up.  For example if you have long standing knee pain that is aggravated each time you run icing post run will help decrease pain and any swelling associated with the activity.  Ice can also be used after more aggressive soft tissue treatments such as Active Release Technique to help reduce post treatment soreness.  Some tips to keep in mind when icing include:

• Never apply the ice directly to the skin, placing a tea towel or an article of clothing between the skin and the ice pack to prevent frost bite from occurring
• Ice for only 10 minutes at a time allowing for 10 minute between icing for the ice pack to go back into the freezer and for the skin to warm back up to room temperature. Therefore, proper protocol is 10 minutes on, 10 minutes off, 10 minutes on
• Ice can be used several times per day

Heat is the best protocol for chronic injuries where no swelling is present.  It is also a great at home treatment option for sore stiff muscles after a long day at work, say sitting at a desk in front of a computer.  Heat will bring blood flow to the area to help reduce muscle spasm and aid in the healing process.  Some tips to keep in mind when heating include:

• Using a moist heat source such as a hot damp towel is always better than using a dry heat source.
• Never apply heat directly to the skin, ensure that enough layers are present between the heat source and the skin to avoid burns
• Heat should be used for no more than 15-20 minutes at a time

Finally, alternating between ice and heat is a great at home treatment method for injuries that are in the sub acute phase, meaning they are more than a couple days old but less than a few weeks.  This protocol will help reduce swelling and increase the body’s healing mechanisms.  When using this protocol the ratio of heat to ice should be 3 minutes to 1 minute always ending with an icing phase.

Although icing and heating are great at home strategies it is best to remember they are always more beneficial when used in conjunction with other treatment methods such as chiropractic manipulation, soft tissue therapies, stretching, or physical therapy.

Dr. Chiarelli DC is a Chiropractor who practices integrative medicine at IHI. She believes in utilizing a number of techniques such as Contemporary Medical Acupuncture, joint manipulation, and ART (Active Release Technique) with the aim of improving function and reducing pain for her clients.

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