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Hot or Cold, What to do to fix you?

Welcome to fernwood health & performance’s blog!

We hope you’ll follow along, read, comment, and get to know each of our practitioners throughout our posts.

So – What’s first?

Well, so many of you ran the Oak Bay Half Marathon this past weekend (Congrats to all who participated), I’m sure there’s more than a couple people nursing a few pulls, strains, sprains, and general soreness.  So what do you do about it?  Do you use ice?  Heat?  Does it matter?  Should you use both?  When?

Well, welcome to the Great Debate – hopefully we can clear up some of the confusion, and get you on the road to feeling better!

Generally speaking ice is used for controlling pain and inflammation.  Meanwhile heat is usually used for easing soreness due to spasms in muscles. Now it’s important not to mix those up!  Never apply heat to anything that’s swollen, as that can cause things to get much worse with further inflammation.

When an injury is fresh (the first 24 – 72 hours), your safest bet is ice.  This helps to close off the small blood vessels which will control the inflammation process.

Now how long to ice for?  Are you one of those “I’ve been icing my ankle for the past hour” kind?  If so, you’re going too long!  The best protocol for icing is to ice the affected area for 10-20 min with a thin cloth between the ice pack and the skin. Ensure you take a rest of one hour between icing so you don’t get any symptoms of freezer burn.

However, for every rule there’s an exception, right?  Here’s the exception for ice – never ice a muscle that is in spasm with no injury of strain or tear to the muscle.  Frequently spasms in the low back or neck pain can feel like an inflamed muscle, making you want to use ice.  But if it’s actually a clenching muscle in spasm and you ice it, you’re likely to cause the contraction to get worse, not better! Heat is best applied to reduce tension in a muscle, releasing spasms.

OK, so is this confusing now, or what?  You’re supposed to ice new injuries except for muscles in spasm, but at the same time not put heat on a fresh injury that could be swollen or inflamed.  So……what do you do about injured muscles?

A serious muscle injury almost always presents with severe, sharp pain, in which case use the ice to bring down the inflammation, but only for the 24-72 hours, then you can move onto heat to help calm any spasm in the muscle. After 72 hours it is fairly safe to use ice or heat depending on what makes you feel better as the inflammation cycle should be mostly complete.

Now what about this thing called contrast bathing?

Were you ever young and in a hot tub when there was snow around?  If so, chances are you (or that friend you dared to) jumped out of the hot tub, ran and rolled through the snow, and jumped back in. A bit of a shock to the system, right??  Well, that’s contrast bathing.

Don’t worry though – we have a much more dignified way of doing it :)

Contrast bathing is a wonderful way to help speed the healing process.  It’s best used to treat issues like shin splints, or muscle/tendon injuries.  When it’s done properly, the ice constricts the blood vessels, forcing the blood away from the injury.  Switch to heat, and your body sends fresh, nutrient rich blood to the same site.  Do it multiple times in a row, and your blood vessels act like a pump to continuously bring fresh blood to help speed healing.

So – how to do it?  It’s simple – alternate hot and cold for either 30 or for maximum results, 50 minutes a day post injury.  Remember though that you are ALWAYS starting and ending on hot.

For hot – submerge the area (ie. legs) in hot/warm bath.  Heat packs do work, but in this case are less effective.

For cold – ice pack applied to the area.

A 30 minute treatment would look like this:

  • 10 minute hot
  • 10 minute cold
  • 10 minute hot

For 50 minutes (a great chance to get some alone time with that book you’ve been meaning to finish):

  • 10 minutes hot
  • 10 minutes cold
  • 10 minutes hot
  • 10 minutes cold
  • 10 minutes hot

Give it a try for a few days after exercise and see if it helps :)

By Scott Okrainetz, MPT

Physiotherapist