To heat, or to ice? A very common question I hear in the clinic and over the years I worked as an Athletic Therapist managing injuries, on and off the field. A fair question since there has been so much changing research over the years. So…while Ananta Wellness & Osteopathy has temporarily closed its doors while we are practicing social distancing – I thought that this would be a perfect time to offer some clarity on the debate.

Injury Management while you’re at home

During this challenging time during COVID-19 you are probably noticing how much your daily routine has changed. Whether it’s working from home with a new work station, being more sedentary, hunching over a puzzle at the kitchen table, doing more online or Instagram live workouts or even getting outside more to run or cycle – you are likely challenging or moving your body in ways that it may not be used to. And with all that change you we might be starting to notice some new aches and pains or some old ones’ creeping back into our body.

Did you know that you have two options to help alleviate those aches and pains right in your own home –  cryotherapy and thermotherapy? Cryotherapy is the use of cold temperatures, and thermotherapy is the use of hot temperature on injured tissue to help with healing and symptom management. Both are easy, cheap, accessible pain management tools to use! And although heat is definitely the more favourable choice, I will explain why it may not be the best choice for every situation.

How Ice Helps Acute Injuries

The recommendations of cryotherapy, ice application, for acute injuries has changed many times over the years. You may even recall many of the acronyms, such as, RICE or PRICE used to help remember what to do after an injury (i.e. protection, rest, ice, compression, elevation). An injury that is defined as “acute” is when damaged tissue results after a specific event or mechanism. So what does that all mean, and why is ICE recommended?

Ice helps calm down the damaged inflamed tissue by causing vasoconstriction. Vasoconstriction – is the narrowing of the blood vessels, which will slow down the blood flow in the body. Not sure if you have an Acute Injury? – here are the signs of an acute inflammation: Redness, Heat and Swelling. If you see any of these signs, icing is the best and safest initial treatment for the first 48-72 hours after an injury.

Pain is a complex and subjective experience. It is affected by many different factors such as cognition, genetics, and mood. Cryotherapy can also be very effective way to decreased pain through a few different ways. One way is through the gate control theory of pain. This happens by stimulating nerve fibers that are responsive to touch which then excite inhibitory neurons to diminish the transmission of pain signal to the brain. Have you ever noticed when you bang your elbow, or get a small cut that it feels better when you simply apply pressure? This is due to the gate control pain theory!

Recommendations for ICE application:

When: icing is the best and safest initial treatment for the first 48-72 hours after an injury

Where: surface area, direct

How long: The length of time you should ice depends on the targeted area. Many factors such as how deep the tissue is, and what other tissues are located in close proximity, such as nerves, are important factors in deciding duration. Usually 5-15 minutes is sufficient due to more recent research that has come out showing moderate cooling is better than excessive. This theory is based on facts that excessive icing (increased duration) will cause too fast of a change in size, leaving less room for blood and lymph to move through the body and slow down the healing process.

How often: If you ice multiple times a day, just making sure you give the tissue enough time to completely warm back up to normal temperature, 1-2hour break. It is important to initially ice and elevate to decrease the swelling, as well as to decrease the pain to make the recovery process more endurable.

With what: – There are many different choices of ice you can use from ice cubes, frozen peas, or artificial ice pack, and of those options – there are definitely ones that are more effective. If you are using an artificial ice pack never apply these directly to the skin and watch the time closely. These ice packs are filled with chemicals and unlike frozen water it won’t melt to the temperature of your skin so it can cause damage if it is left too long. The most effective way to ice will depend on the area of body. One of the best ways is to use a large ice cube and massage it over the skin. This is difficult if you cannot reach the affected area or you don’t have someone who can help you, in this case you may choose to use an ice pack. Ice immersion is also a great way to cool down the tissue by filling water and ice in a bucket/tub. Again, this can be easy for your extremities but difficult for more central areas of your body unless you want to have a full ice bath, eek! It is always a good idea to put a towel between your skin and the ice pack even if it is not artificial. If you do not feel the area is getting cold enough with the dry towel, you can try placing a wet towel instead which will cool down the tissue more.

When not to ICE: You should never ice an injury right before activity, as well as here are some contraindications to cryotherapy:

• Hypersensitivity to cold – Look for signs such as the formation of red hives/welts
• Circulatory disorders/disease: such as Raynaud’s, or large impairments to your circulation
• Open wounds
• Impaired sensation; anesthesia (local)

How HEAT Helps with Injuries

Thermotherapy is typically used for stiff, sore muscles, and chronic pain – not for Acute injury management. Applying direct moist or dry heat to the affected area relaxes the muscles which helps to relieve pain and reduce spasm. It also increases blood vessel dilatation that helps to stimulate healing. There is strong research that demonstrates heat helps with chronic conditions such as arthritis, chronic lower back pain, and stress.

Recommendations for HEAT application:

When: typically used for stiff, sore muscles, and chronic pain

Where: Directly on the surface of the affected area

How long: Heating for approximately 15-20 minutes has shown to be sufficient. Just like icing, depending on the level of tissue you are targeting, superficial or deep, will be a factor in how long you heat an area. Moist heat compared to dry heat has been shown to have less skin irritation, sink into the tissue deeper and faster.

How often: 1-2 times a day

With what: With a hot water bottle or artificial heat pack you should always place a moist towel between the pack and your skin. If those tools are not available to you, having a warm bath/shower can also be effective.

When not to HEAT: Just like cryotherapy, heat therapy has some contraindication such as:

• Deep vein thrombosis DVT
• Active inflammation; area is hot and/or red
• Dermatitis
• Open wound
• Vascular disease
• Multiple sclerosis (MS)
• Impaired sensation; anesthesia (local)

As we are in a time of self-isolation, not only can we have more physical aches, but also emotional and psychological implications. Social distancing is hard for many people since human connections is a huge part of our lives. Extra stress brought on by this global pandemic can translate into physical pain. Everyone’s de-stressing tools are different but common ones include thermotherapy such as a hot shower or bath, reading by a warm fire, or drinking a hot cup of tea. Try using one of these de-stressing techniques, or finding the one that works for you!

Contrast therapy: Heat and Ice Combined

Alternating between the application of heat and ice is called contrast therapy and has been shown to facilitate injury healing as well, but this is not to be done in the “acute stage”. This is helpful for reoccurring chronic injury by helping to improve circulation to the area. This has been shown to improve mobility and decrease pain in cases of plantar fasciitis, Achilles tendinitis, hand and foot arthritis and fractures just out of a cast. Contrast therapy works due to the change in temperatures open and close the blood vessels which creates a pumping action, therefore can also help with swelling. The most effective way to do contrast therapy is through full immersion in hot and cold water because this covers more surface area. You are able to use hot and cold packs, but research has shown it to be less effective.

Recommendations for how to use Contrast Therapy:

Set up: You will need two tubs/buckets. One with hot water and the other with cold ice water. You can use your bathtub for the warm water, and typically a bucket for the cold.

The warm tub should be between 98-110 degrees, and the cold tub should be between 50-60 degrees.

Duration: Begin in the warm tub. Immerse the area fully for 3 minutes, then transition to the cold for 1 minute. The cold tub is harder to tolerate, if you’re not able to withstand the 1 minute then shorten the time.

Repeat this until the water temperature come to room temperatures. Ending with cold or heat will depend on the type of condition you are trying to treat. If you are doing this with a chronic injury that is swollen, end in the cold, and if you are doing this with an arthritic/stiff injury, end with warm.

General Guidelines

Here are a few general guidelines for heat and ice application if you are not able to see your health care practitioner right away:

• Heat is also used before activity, and cryotherapy after activity
• Never apply ice directly to the skin, and be wary of the temperature of a heat pad; wrapping a towel around
• Cryotherapy is for an injury
• Thermotherapy is for stiff muscles
• If either are painful, stop!

Coupling these therapies with exercise is important especially during this time while you are not able to get the hands-on therapy by your Athletic Therapist and Osteopathic Practitioner. Movement is one of the best cures for muscle and joint pain. This has many different meanings depending on your activity level, from doing light stretches at your desk, going for walks, or doing your favourite strengthening exercises. Athletic Therapist and Osteopathic Practitioners can help give you more specific directions for pain management techniques, as well as active rehabilitation exercises to assist with your healing process.

Given this unique time, the Practitioners at Ananta Wellness & Osteopathy are committed to helping you out as best we can. Please don’t hesitate to contact us if you have any questions or concerns or to book a one on one Telehealth appointment!

We do recognize that it is not as easy as it was a couple months ago to book a doctor’s appointment or go into the emergency room – so we are here to help with any questions you may have. Our Practitioners at Ananta Wellness & Osteopathy do not diagnose but we can offer recommendations if further referral or investigation(s) are necessary. If you are concerned at about a possible fracture or underlining issue, medical pathology or disease – we asked you to consult your physician.