COLD OR HEAT? WHICH PACK AFTER INJURY

Why does it matter: 

Both Heat and ice reduce the pain but in different ways as Heat can reduce pain by relaxing muscle fibres.

Ice suppress the nerve stimulation of affected area. So, which pack you should apply after injury, to understand this you should know what changes does heat and cold to your body.

How does it work :

· Cold reduces blood flow (Vasoconstriction) and inflammation producing activity on the site of injury thus result in reduction of inflammation of affected site, which in turn decrease pain due to inflammation.
· Heat increases the blood flow (Vasodilation) and metabolic rate which enhance inflammation after injury, increased blood flow removes waste product (debris) from the injury site and improve healing process.

Then what so much of good thing about ice, Ice is good in recent injury where it slows down the inflammation process and save you from unbearable pain like for 2-3 days after sprain (ligament injury).

Now you must be confuse isn't the Heat is bad for you but it will be in recent (acute) injury but not in chronic(old) injury, it’s the best medium to heal that injured part that is after 2 – 3 days of injury.

Time Duration:

· Always remember generally after injury use ice pack, as it is said earlier acute (recent) injury requires less blood supply so that it will reduce the chances of inflammation.
· In general use cold pack in between 2-3 Days of injury. Also helps in reducing pain sensation.Now after 3-4^th day, Go with the hot pack as your injured part is healed up and stiffed and to reduce muscle pain which is generating due to immobilisation.

· For Ice apply only for 10 -15 minutes. Not to use directly on skin but to wrap a towel between ice and skin. A small time for application is to avoid the chances of frost bite.

· For Heat apply for 15 - 20 min not more than that and always first touch the heat pad to skin to check that you are not using too hot for the affected part as at the time when you are using the pack the sensation might be low because of thickness of muscle. So it’s better to know the optimal temperature and wrap it under towel and then place it above the affected area.

Which one is a better option: 

This question in general depends on the condition of injury as it is a recent or 3-4 day old injury.

Ice therapy used to:

· Reduce pain

· Reduce spasticity

· Reduce muscle spasm

· Reduce swelling

· Promote Repair

· Promote excitatory stimulus when muscles are inhibited.

Heat therapy used to:

· Increased metabolic activity
· Increased blood flow
· stimulation of neural receptors in the skin or tissue
· Muscle relaxation
· Increased activity of sweat glands.

When not to use ice:

· Psychological

· Cardiac Condition.(6 month after a myocardial infarct ice condition should be avoided)

· Peripheral nerve injury

· Vasospastic Disease

· Peripheral vascular disease

· Cold sensitivity.

Heat not to use in:

· Damaged skin

· Open wound

· Allergic Rash

· Skin Condition

· Impared skin sensation

· Defective arterial blood supply

Advisory note:

During first 3 day’s of your injury use ice. After passing those 3 day’s go with heat.Ice cause tightness, stiffness and vasoconstriction, giving a great time period for ligament to heal to optimal period.Heat comes after ice to cure that stiffness and bring back vasodilatation. But using heat immediate after injury will aggravate the pain and inflammatory condition.

Conclusion:

Both Ice and Heat have their own terms of benefit with respect to the condition.If the injury is acute the Ice is a better option but when the injury is chronic Heat is a good option.you can never judge one without knowing the conditional effect of each one on the injured part.So its better to know the character of effect of both the packs.

I Hope now you must be able to understand that whenever you twist your ankle why your Therapist/Doctor ask you to Apply the Ice pack over the hot and after three days of application ask you to go with hot pack.

 Suggestion:

If you like you can also read this research article "The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner" 

https://www.preventworkinjury.com/wp-content/uploads/2014/10/Heat-vs-Cold-Therapy.pdf

· 

By Kunwar Karan Singh (Physiotherapist).