Do You Use Heat or Ice for an Injury?

By Paul A. McElderry, L.Ac., LMT, MS

In my practice I’d say that about 60 to 70 percent of my patients come in for some type of musculoskeletal issue, whether its back pain, ankle pain, shoulder pain or your basic strain or sprain. Most of them are not sure whether they should be using heat or ice therapy and the ones that do somewhat know really don't know how to properly apply them.

Lets start off with some basics. You have two major classifications, acute injuries and chronic injuries.

Acute injuries are injuries that just happen, like when you twist your ankle, bag your knee, or pull a muscle. The first 48 to 72 hours of these injuries are considered acute. Usually the area is swollen, red and warm to the touch. The pain is usually very sharp. This means there’s inflammation. Just think of it like this: if something is in"flamed" we need to cool it down and not heat it up. So an acronym for our basic rule of thumb is R.I.C.E.: Rest, Ice, Compression, Elevation

Rest it, as to as not to aggravate or further inflame it. Ice it to reduce swelling and inflammation. Compression to prevent excess swelling. Elevate injury (if you can) above the heart to reduce the swelling.

Chronic injuries usually last from a week to possibly years. These conditions are more achy in nature. These would be more suitably treated with heat. The only exception to this rule is a re-exacerbation, (re-injure or flare up) of a chronic condition. This pain would also be sharp in nature and should be treated as an acute condition.

Now that we understand what conditions call for what kind of therapy, we need to look at how we apply them. I usually tell my patients to keep the heat or cold on for 10 to 15 minutes and off for 20 to 30 minutes and to repeat it at least 2 to 3 times more per day.

Now I have heard many times from my patients, "I put heat on it last night when I went to sleep and it felt great but when I woke up this morning I was in a worse condition."

This is because they kept it on for too long. There is a reason why we don’t keep either heat or cold on for longer than 15 minutes. Let me first explain the purpose of each therapy.

The purpose of heat is to vasodialate (open up the blood vessels to allow more blood flow) and the purpose of cold is to vasoconstrict (close up the blood vessel to prevent swelling).

We have temperature receptors in our skin that also control your blood vessels. So when we try to improve circulation of blood with heat, if the heat is left on for too long those temperature receptors tell the brain that the area is too warm and the blood vessels will then vasoconstric. The opposite happens with cold therapy. We leave the therapy off for double the amount of time that we’ve had it on so as to let our skin return to room temperature so that we may reapply the therapy again.

Lastly, I will also tell my patients to drink a lot of water. Toxins will build up at the injury site and will need to be flushed out of the body. By not properly flushing your system out, you will prolong your recovery time.

These few helpful hints should either keep you out of my office or help you more quickly on your road to recovery.

Paul McElderry is an NCCAOM Board Certified practitioner of East Asian Medicine. He has been studying Traditional Chinese Medicine since 2000 when he enrolled in New York College of Health professions. He also received other advanced training in neurology, myology, pathophysiology and Eastern and Western nutrition.

Paul  is the owner/practitioner of the located at 713 Main Street, in Port Jefferson, specializing in Acupuncture, Herbal Medicine, Medical Massage and Nutritional Counseling.