The number one mistake I hear from a new patient is that they are using heat on
their injury. Whether their doctor told them, the ER or some old wise tale about
first 48 hours ice and then use heat. Bottom line if you use the word pain, pain is
caused from inflammation and therefore use ICE!
While ice may not be the most comfortable thing to put on your body, your injured
tissue will thank you! Putting ice on the area is important as it:
Slows down circulation which reduces inflammation.
Numbs the area to reduce pain.
The above steps allow the body to heal faster.
While heat is much more comforting, the heating process actually can make your
problem worse. Heat has the complete opposite effect on the joint, by increasing
blood flow and inflammation. So hot packs, hot water bottles, whirlpool baths and
heating pads should all be avoided initially. If you choose to soak in a hot bath or
whirlpool, follow your bath with an ice treatment over the affected area.
The therapeutic effects of ice are experienced within the first 15 minutes. After
that, the response actually reverses as your body acts to save the frozen area by
increasing circulation to the area. We do not want those side effects. You can ice
hourly, just always for no longer that 15 minutes.
With this in mind, do not fall asleep with the ice pack in bed as you may wake up
• Always place a towel between the ice pack and your skin.
• If possible, elevate the inflamed joint and place it in a “neutral” pain free position.
• Ice for 15 minutes, after 60 minutes of no ice.
Icing is most beneficial if it is followed by controlled pain free range of motion in
all directions of the joint.
Second option is called ice massage:
This requires a second person to be done properly. Freeze a small Dixie cup full of
water until completely frozen. Tear a small amount of the paper cup from around
the top. Massage with the ice in either a slow circular or up and down motion, with
as much force as can be tolerated without discomfort for 3 to 6 minutes. Follow
with 3 gentle stretches of the area, if possible with minimal pain. Follow with
active pain free range of motion, in all directions. Repeat process every 2 hours.
After an injury, when in doubt, always ice.
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