Heat or Ice ?

The other day I got injured and was reminded of the healing properties of getting ice onto the site as soon as possible. I stepped into an open hatch and my leg went down all the way, bruising my leg all the way to the knee. My whole inner thigh swelled up red and hot. After a dialogue on the boat about heat or ice, I nursed it on the way home, and then my wife said, “hey remember how you tell your patients to ice?”  I said, “oh, yeah, right!”… I put ice on, and despite the inital shock, it felt better. I put a moist barrier in between me and the pack, and strapped the pack on with some Kling wrap (like an ACE bandage). Anyway, I did this one more time that night. The next morning, the leg LOOKED terrible, but it was hardly swollen and the pain was so much reduced compared to what I thought it would be. I credit this to rapid deployment of the ice pack. I often send people out of the clinic with ice packs when they are needed after appointments.  Ice can really slow the swelling process down and set the stage for repair.

So anyway, days later, (in short pants) the leg still looks frightful, but it is remarkably less painful than everyone thinks. The next day, it felt quite a bit like it was healing. I credit it to (my wife) getting the ice on there.  Of course, I appreciate all the “put heat on it” helpers, but we just don’t agree.  For more on heat or ice, check out the Frequently Asked Questions on the main page.  Oh, by the way, my adjusting is not effected at all! No worries about me! Thanks.

Ice promotes decreased inflammation and healing; Heat tends to bring fluid into an area, promotes inflammation, and can cause fluids to fibrose (become like spiderwebscar-tissue). Often when a patient has a problem that is still hanging around a week later, it’s because they “heated”. So…. heat or ice?

The strategy is to initially ice while there is injury. Ice for Injury; heat for tightness (much later). No heat for the initial injury stage. At least 72 hours later, maybe what you can do is begin alternating Ice and heat, ending with Ice. Go for getting it good and cold; break the cold with the heat, don’t overdo the heat, even though you probably will want to. Later, when almost fully recovered, maybe just heat. Heat is typically for getting you ready to exercise, to assist with stretching, before massage, or when getting treated; it’s not really an injury modality.  more of a “chronic” thing, but let’s discuss that.  By the way, heating an acute joint injury (as opposed to a muscle injury) definitely causes more fluid in the area than is neccessary.

Again, there are some FAQ (Frequently Asked Questions) about this. Let’s talk about it in the clinic, we can do a lot more, get some treatment!