One question many athletes ask when they get injured, is which is the best to use, ice or heat? To answer that question we must first look at the physiology behind the healing process. There are three stages that our bodies go through as we heal:
- The Acute Stage,
- The Subacute Stage,
- and The Chronic stage.
The Acute Stage
The Acute stage (also known as the Inflammatory phase) of healing starts at the time of injury and generally lasts 5 to 7 days. During this time there is a build up of mast cells in the bloodstream from the injured tissues with a resultant release of histamine. Histamine acts as a microcirculatory vasodilator and increases blood vessel protein permeability causing visible edema in the injured area. (Vander 733)
At this stage rest, ice, compression, and elevation (RICE) should be combined to reduce the amount of vasodilation taking place in the blood vessels and to reduce the edema in the injured body part.
Common indications for ice include:
- Reduction of acute pain.
- Reduction of local bleeding and swelling.
- Reduction of muscle spasm, and treatment of acute burn.
Common contraindications for ice include:
- Previous exposure to frostbite in that area of the body.
- Compromised circulation.
- And in those people who are sensitive to cold.
One must be careful to avoid prolonged application of ice. If exposure to ice is prolonged, tissue damage may occur. After 15 -30 minutes of use, depending on the structure's vascular status, blood flow to the area increases. This is known as the "Lewis' hunting phenomenon".
This is best observed in persons who are outside for longer amounts of time in the cold weather. You will notice a reddening of the cheeks and other uncovered areas even though they are still exposed to the cold air.
If time exposed to extreme cold is longer than 1-3 hours than this phenomenon will cease to occur and permanent tissue damage will most likely develop. With all that in mind, it is best to apply ice to an injured area for no longer than 20 minutes at a time every hour as needed. (Hecox 201)
The Subacute Stage
The next stage, the Subacute or Fibroblastic phase of healing, usually lasts up to 3 weeks after the injury depending on the severity. This stage is characterized by synthesis of collagen from fibroblasts (a type of connective tissue cell) and scar formation. Ice may still be used in this phase for pain control and control of swelling.
During this phase you may want to start using local heating agents rather than ice to assist with healing of the injured tissues. Some common indications for the use of heat are: before active exercise or stretching and in the presence of muscle spasm.
Heat should not be used if:
- Bleeding or edema are still present.
- In areas of poor circulation.
- In areas of decreased sensation (especially in the young and old).
- In the presence of an underlying blood clot.
- And if presence of skin or lymphatic cancer or local infection.
When applying heat to a portion of the body the same guidelines hold true as with ice. Do not use heat for longer than 20 minutes at a time every hour as needed. (Hecox 126)
The Chronic Stage
The final phase is the Chronic or remodeling stage. This stage will last from 6 months to 1 year after the injury. During this phase the collagen synthesis continues, however the scar does not enlarge. Ice and heat may be used interchangeably here, depending on the desired outcome to be acheived, and have even been used together (Contrast-bath) for such conditions as ankle sprains.
In summary, ice and heat may be used throughout the healing process depending on the stage and the severity of the injury. The RICE method should always be started immediately after, or as soon as possible after an injury. Do not apply ice for longer than 20 minutes at a time every hour as needed.
After the first 5 to 7 days, the Subacute stage, if there is no visible sign of swelling you may begin heat to assist with pain control by reducing muscle spasm. Again, do not apply heat for longer than 20 minutes every hour as needed. Ice may also be used to numb the area and assist with pain control during this phase and also to control any residual swelling.
Finally, in the Chronic stage ice and heat may be combined depending on the location of the injury. You may wish to start out with heat before a workout or activity and then end with ice to reduce any inflammation incurred from muscle tissue damage while working out.
Homemade Ice Pack Recipe
A quick and easy recipe to make a reusable slushy ice pack is to combine 4 parts rubbing alcohol to 1 part water and ice cubes in a plastic seal up baggie. Place this in the refrigerator for a few hours and when it is ready you will have an inexpensive ice pack.
The reason this works is that the specific temperature of the rubbing alcohol is low enough that it will not freeze in a normal freezer, allowing the contents of the bag to form a slush rather than a solid.
However, you will want to make sure you mark this bag as poisonous so that the contents don't end up in someone's drink the next time you have company. You can also use a bag of frozen vegetables which will work just as well.
1. Hecox B, Mehreteab TA, Weisberg J. Physical Agents: A Comprehensive Text for Physical
Therapists. Norwalk, CT.Appleton and Lange; 1994.
2. Vander AJ, Sherman JH, Luciano DS. Human Physiology. 6th ed. New York, NY. McGraw-Hill, Inc.;
1994: Chapter 20.
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