Ice or Heat:
What Works Best with Mild Injuries?
By Danieal O’Ferrell, ATC
Recreational, student, and professional athletes all have a common link: each is physically active and thus, susceptible to mild injuries. Whether you are a parent, coach, or weekend warrior, many treatments are available for such injuries. Two of the most available, affordable, and useful treatments for mild injuries are the use of ice or heat for healing and soothing therapy. For injured athletes, questions regarding the use of ice or heat therapy should be directed to your athletic trainer.
Cold therapy is commonly used in conjunction with acute or traumatic injuries.
Tissue damage occurs after injury as a result of compromised circulation. The immediate application of cold therapy causes blood and lymph vessel size to decrease, which minimizes the amount of initial swelling and bruising that can occur after an injury. Cold therapy treatments lower the amount of oxygen needed by body tissues, causing less damage and thus, taking less time to heal.
Cold therapy is recommended during the first 24 to 72 hours after injury or until bleeding and swelling has stopped. However, as with many injuries, treatments can need to be continued for several weeks. Four stages of body sensation occur during application: cold (or chill), burning, aching, and numbness. These sensations help decrease the physical pain of an injury. Time of treatment varies, depending on the method of cold treatment being used and the amount of fat cells present in the injured area. Cold penetrates the skin more deeply than heat, and tends to have longer lasting effects than heat. After administering cold therapy, the treatment area should always be given time to warm up again before returning to physical activity.
When and When Not to use Cold Therapy
Cold therapy is recommended for symptoms such as acute swelling, muscle strains, ligament sprains, and contusions (bruising). Acute or sub-acute inflammation and pain is often treated with cold therapy. Cold is often applied to aid with conditions such as: muscle soreness, tendonitis (inflammation of tendons), tenosynovitis (inflammation of tendon sheaths), bursitis (inflammation of bursa, or saclike cavities in tissue), muscle spasms, guarding, and superficial first-degree burns. Cold treatments are often used after surgery to reduce pain and swelling, and during rehabilitation to lessen pain, muscle spasms, as well as aid in movement of an injured area.
Although cold therapy can be useful in many situations, it is not appropriate for all injuries. For instance, cold therapy is not recommended for patients with circulation or nerve impairments, such as: peripheral vascular disease, Raynaud’s disease, or loss of skin sensation. Cold allergies that can produce hives, joint pain, and swelling of the injury site are not suited for this type treatment. Also, using cold therapy with heart and lung disorders is not advised. Lastly, arthritis, in addition to certain skin conditions (eg, uncovered, open wounds) should not be cared for in this manner.
Available Types of Cold Therapy
Ice massages are an inexpensive cold therapy for small areas of treatment (approximately 10 x 5 cm) and involve continuous, overlapping circles for approximately 5 to 10 minutes. You can use a wooden tongue depressor in a cup or a paper cup torn below the ice level to provide a handle. Ice massages are typically used over a muscle belly, tendon, bursa, or an area prone to muscle spasms.
Ice packs are also easy to use and maintain a constant temperature. Ice packs can be molded to fit the body’s shape and can be held in place with a wrap. Distal extremities can be elevated to help minimize swelling. Recommended treatment time is 20 to 30 minutes. The treatment site should be checked periodically for cold allergy symptoms. Should these symptoms occur, discontinue treatment immediately. For larger treatment areas, ice immersion baths are used to cover an entire distal limb. Used with a compression wrap to reduce swelling, a variety of containers can be used to soak the limb. Treatment time generally lasts 5 to 15 minutes, or until pain is relieved.
Commercial gels and chemical packs are a convenient method of treatment and are used in the same manner as ice packs. Although gels and chemical packs are equally effective, they tend to be more expensive than other methods. Gel packs are frozen for about 2 hours prior to application, and should be wrapped with a wet towel or cloth before placed on the skin. Chemical packs are disposable and appropriate for mild first-aid situations. Because skin burns can occur from a ruptured chemical pack, the packs should always be placed inside another bag before being used.
Heat therapy is commonly used in the second phase of healing after swelling and bruising have ceased. Heat therapy causes blood and lymph vessels to enlarge. Increased blood supply to the injury site provides oxygen and nutrients. Lymph vessels assist with the healing of edema (abnormal collections of fluid) and bruising. Used at the proper time, heat can decrease pain and the occurrence of muscle spasms. When used prior to stretching and exercise, heat improves flexibility and enhances mobility. However, when used improperly, swelling and bruising can increase dramatically and lead to longer recovery time.
Superficial heat therapies include whirlpools, hot tubs, moist heat packs, and paraffin (wax treatment) baths. To increase the temperature of deep body structures or tissue under large amounts of fat, deep-heating modalities should be used to prevent skin burns. Deep heat therapies often include the use of machines, such as an ultrasound or diathermy. These types of therapy are only available through a licensed provider.
When and When Not to use Heat Therapy
Heat therapy is recommended for non-acute or chronic injuries and areas of inflammation to reduce swelling and bruising, as well as relieve muscle spasms. Heat is also suggested for treatment of non-acute muscle strains, ligament sprains, and contusions. Heat is particularly useful in increasing mobility, easing joint stiffness, and decreasing pain.
While heat therapy often provides positive results, it should not be used for all injuries. Heat should not be used immediately after injury has occurred, or to an area of acute inflammation. Areas that have poor circulation, sensation, or malignancy should not be subject to heat therapy. In addition, heat should not be applied to open wounds and certain skin conditions. Above all, heat should never be used directly on eyes, genitalia, or over the abdomen during pregnancy.
Types of Superficial Heat Therapy Available
In terms of heat therapy; heating pads and moist heat packs can be used interchangeably. Moist heat causes a greater increase in tissue temperature than dry heat. However, dry heat can be tolerated at higher temperatures. Heating pads are often used for at-home care, while moist heat therapy is available in athletic training rooms and rehab clinics. It is important to keep in mind that deep muscles and body tissue are not significantly heated through use of these methods. For safety reasons, patients should never lie directly on top of a heat source. Most heat therapy treatments last approximately 20 minutes.
Warm immersion baths and hot tubs are commonly accessible. As with cold therapy, immersion baths are an easy treatment method using a variety of containers at home. When using hot tubs, cleanliness and chlorine levels must be made a concern in order to prevent infections. As with other heat treatments, treatment time should be kept at approximately 20 minutes to avoid dehydration.
Paraffin baths provide heat to contoured, bony areas of the feet, hands, elbows and wrist. Prior to treatment, the injured area should be thoroughly cleaned, as the wax is normally reused. Patients with predispositions to edema or thin scars should not use Paraffin baths. Paraffin bath home kits are often available at local stores. This treatment is commonly used with joint stiffness and limited range of motion. The softening effects of mineral oil are often helpful in keeping the skin pliable during massage. However, the healing qualities of wax are minimal. In addition to these therapies, chemical heat packs are also available and should be used in the same manner as those used in cold therapy.
Arnheim DD, PrenticeWE. Principles of Athletic Training (10th Ed).
Boston: McGraw-Hill. 2000.
Anderson MK, Hall SJ, Martin M. Foundations of Athletic Training (3rd Ed). Philadelphia: Lippincott Williams & Wilkins. 2005.
Prentice WE. Therapeutic Modalities (5th Ed). Boston: McGraw-Hill. 2003.
Danieal O’Ferrell, ATC, was a participant in the Hughston Athletic Training Fellowship Program, Columbus, Georgia, from 2007-2008. She received her Bachelors of Science Degree in Athletic Training from Troy University, Troy, Alabama. In addition to her athletic training certification, Danieal is a nationally registered emergency medical technician (EMT-B).
Danieal O’Ferrell, ATC on Ice or Heat