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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:
1. The Acute
Stage,
2. The
Subacute
Stage,
3. 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
contra-indications
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
Sub-acute
Stage
The next
stage, the
Sub-acute 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 achieved,
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.
Bibliography
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.;
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