One question I get asked a lot in the clinic is whether ice or heat is appropriate for an acute injury. Given that they are polar opposites, I can appreciate the confusion and concern that the wrong one will make things a lot worse.

Ice
Ice is appropriate for injuries where a large or strong inflammatory reaction has occurred and significant swelling or bruising is obvious. This could include fractures, ligament or tendon tears, muscle strains, contusions and bumps. Examples of these injuries are ankle sprains, lower limb muscle tears (calf, quad, hamstring), acute knee injuries like an ACL rupture and finger dislocations. These injuries feature significant bleeding or swelling, pain and loss of range and function. Ice in this instance can help in a few ways. It causes constriction of the blood vessels which can minimise bleeding and swelling. It is also good for pain relief. Provided you place a barrier between your skin and the ice to prevent burns (yes, you can burn yourself with ice), it is a relatively safe modality to try, and you can use it wherever and whenever you like. After an acute injury, get the ice on as quickly as you can and use it for 10-20 mins every hour. You will get the best effects using it in the first one to three days of an injury, though with significant injuries (and in the post-operative phase), you can use it a lot longer.

Heat
While ice can be used anywhere, comfort levels depending, heat is one I tend to recommend for more specific areas. While inflammation is often a feature of most injuries, when it is in a much smaller area, or much deeper, I would err away from ice which probably isn’t going to have such a significant impact. Instead, these injuries can be marked by the pain it produces in the local muscles which spasm in response to the injury. In this instance, heat can be used for its analgaesic and muscle relaxing qualities. The best examples of injuries that would respond well to heat are any to do with the spine. The neck, upper back and lower back have many anatomical structures that can produce pain but they are often quite deep to the skin, and the inflammatory reaction itself (though it can have significant effects) is often quite small. With the exception of fractures and acute sprains of the joints in the upper back, I would almost always opt for a wheat bag over an ice pack for this pain as the heat tends to relax the muscles and dull the pain. This is particularly true for those pains that have gradually developed over a period of time. You can use a hot water bottle for larger surface areas but a wheat bag will shape itself better to the skin and is easier and safer to reuse.

If you are ever unsure, you can pop in to Healthzone Physiotherapy and ask to chat to one of the staff there about your injury and ways you can manage it. We sell wheat bags and ice packs and have our Game Ready machine that administers continuous ice water through a pressure cuff and is perfect for those lower limb injuries discussed above.

Contact HealthZone Physiotherapy today on (09) 477 2098

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Rebecca graduated from AUT in 2008 with her Bachelor of Health Science in Physiotherapy and started working in a West Auckland private practice. She quickly gained an interest in sports physiotherapy including injury prevention and management. Rebecca worked for four years with premier and reserve club rugby teams including Waitemata and Kumeu / Helensville. She was the physio for the Western Pioneers team in 2012 when they won the North Harbour competition. Rebecca also practiced as a community physiotherapist administering the Otago Exercise Programme which focused on falls prevention for the independent elderly. Through these clients, she developed a curiosity in chronic pain conditions. While she has had plenty of experience in standard post surgical rehabilitation, she took a particular interest in Functional Reactivation Programmes, which work with people suffering persistent pain and complex recoveries post surgery or injury. Rebecca takes an interest in working with clients who have exhausted their channels within the health profession for the management of their pain and enjoys the challenge of helping these patients manage their conditions and return to activities of daily living. To aid in this work, she went on to get her Postgraduate Certificate in Rehabilitation from AUT. Rebecca’s passions include travel, yoga, food, comedy and film – don’t get her started on the topic of movies if you don’t have the time and energy to discuss them with her. She lives in central Auckland and is fiercely local – preferring to commute every day across the bridge than to live any distance away from friends and family!

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