Long live the ice or heat controversy. How could something so simple be so controversial? You’veprobably heard to apply an ice pack for the first 24, 36, 48 or 72 hours. Maybeyou’veheard something else. How long should you apply ice for? How should the ice be applied? Or should you use heat instead?

When it comes to brand new aches and pains, albeit back pain, neck pain, shoulder pain, wrist pain, elbow pain (tennis elbow or golfer’s elbow), ankle sprains, plantar fasciitis pain, I.T. band (iliotibial band) pain, of any other type of muscle, joint or tendon strain, pulled muscles, I tell my patients to remember this one little phrase:

Apply Ice First, Ask Questions Later!

Why? Because new injuries are inflammatory and this means you body is actively trying to heal the injury. It’s rushing white blood cells to the area to remove the damaged tissue and the healing process ensues. Ice cold compresses help contract the surrounding tissue squeezing the building inflammation through lymph system and venous system.

So applying ice is the first thing you do when you have a new (aka: acute) injury, strain, bump or contusion.

In the old days, doctors use to tell their patients to apply heat. The thought being, increasing circulation would help pump out the inflammation. Unfortunately, it reallydoesn’twork like that for acute injuries. But, there’s a little secret that occurs when applying ice that does this very same thing. Have you ever noticed that when you take the ice pack off your skin, your skin appears pink or red? Well, as a result of the extreme cooling of your injury site, your body, in a last ditch effort to prevent frostbite, dilates the blood vessels to warm the area back up. Since frostbite can be a situation where there’s loss of limb or life, the body, innately goes into its primal response of self preservation. Dilating the blood vessels in the area warms the area back up by increasing blood flow, getting the effect the old time physicians were seeking.

When applying ice, my suggestion is to use a gel ice pack. Always apply a thin towel layer (I use a washcloth or handkerchief) to the skin then place the ice pack on top. Leave in place for 10-20 minutes or until the area is numb, whichever comes first.

Apply ice if the symptoms are moderate to severe, sharp, stinging, stabbing, pinching. You may also have a severe aching pain. I’d use ice on this as well. If you’re not sure, call your doctor.

Physiological effects of ice are reduction of pain, reduction of swelling, reduction of muscle spasm.

Applying heat:Heat should be applied to old or chronic injuries, aches and pain. You wake up in the morning and feel achy or stiff in your neck or back or shoulder, etc. Heat increases blood flow, relaxes tight muscles and reduces pain. Moist heat should generally be applied when the pain is mild to moderate, dull, achy or stiff.

The reason you don’t want to put heat on acute, new and fresh injuries is that the new condition is inflamed. The root word being ‘flame’, meaning, the area is hot. Putting heat on an acute injury may feel wonderful at first, however you will be irritating the injury and ultimately causing it to inflame even more. Most of my patients have come back and told me they felt worse within 1-2 hours after applying heat to an acute injury. And, let’s not even discuss those that told me they slept all night on a heating pad. All I can say is: SLOW COOKER! You’re denaturing the proteins in your muscles, tendons, ligaments and permanently damaging them forever!DON’T EVER SLEEP ON A HOT PACK!!!

When you do apply heat, moist heat is the heating method of choice. 15-20 minutes is about all you’ll need, however that will better be determined by body size and size of the part needed the heat. You’ll also need appropriate toweling to avoid burning your skin. Check with the manufacturer’s instructions for the particular heating pad or heating device you are using.

There are many more precautions when applying heat. Absolutely DO NOT apply heat to muscle contusions, and the list goes on. Heating of muscle contusions has been known to cause a condition known as Myositis Ossificans. Per the name of the condition, inflaming the muscle tissue to the point where it draws in calcium and becomes ossified, or bone. And because of the structure of the muscle, the bone within the muscle is sickle like, like a blade and can damage the tissue every time you move. Luckily the condition is painful enough to where you don’t want to move it. Rather, you go quickly to an orthopedic surgeon and have it removed. That’s why on a contusion, always apply ice.

Hence my memorable little phrase: Apply ice first, ask questions later.

So if you’re reading this, you must have just injured yourself.My first suggestion is to apply ice first and call your doctor immediately to see if he or she agrees.

Remember, I’ve never examined you and probably don’t know you or your particular anatomy. The advice described above is intended to be general in nature and not specific to you. Check with your healthcare professional to find out what is right for your particular injury.

Dr. Todd M. NarsonDiplomate of the American Chiropractic Board of Sports PhysiciansMiami Beach, FL

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