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If there is one question our patients ask us every day it is “should I use ice or heat?” And unfortunately, most of the time they have guessed incorrectly!

Let’s see if we can answer this question for all of you weekend warriors and desk jockeys out there.

First of all, the good news is even if you’ve been doing it wrong, you probably haven’t done any permanent damage; you’ve just deprived yourself of some much needed relief.

I’ll start with the ‘text book’ answer:

For acute injuries (0-72 hours after injury) ice on and off for 15-20, protecting your skin from ice burn by wrapping a paper towel around the ice pack (frozen peas or corn work great in a pinch, a bag with crushed ice is ideal, gel packs are convenient and also effective) and don’t lay directly on the ice pack. This should be repeated between 3-6 times depending on the severity of the injury. During this crucial time period following an injury fluid rushes into the area. If we can decrease the amount of fluid in an area, it will decrease the pain and shorten the healing time. Examples of these injuries are sprained ankles, strained muscles, swelling and other injuries typically involving twisting, over stretching or trauma.

For sub-acute injuries (72 hours to 2 or 3 weeks) you can use a combination of alternating ice and heat, 15-20 minutes with each for 3 repetitions, try to finish with ice for best results. During this time period we are still trying to reduce swelling but now it is not about stopping the influx of fluid but about pushing the fluid out of the area. A combination of heat, ice and light massage can aid in this process.

For chronic injuries (3 weeks or longer) stick with heat for 15-20 minutes with a 20-30 minute break in between. Now we have an injury that is no longer healing well, meaning there is not sufficient blood flow in the area, heat is very effective at bringing in fluid and relaxing contracted muscles that set in after a prolonged condition has been present. Examples of these conditions include osteoarthritis and other conditions that present with tightness or stiffness.

Where it gets tricky is knowing, or I should say “realizing”, when you have suffered an exacerbation of a chronic injury which would technically make it an acute injury. If unsure, stick to ice, it has more benefits and less risks than using heat. I know, I know, I hear it every day, “… but heat feels so much better than ice!” while this may be true for the short term, the ice will feel much better over the long term.

One last thing, if you are unsure about the origin of the pain, if it is severe or not improving a period of 3-4 days, the swelling, redness, heat or pain are worsening or spreading you should seek medical advice from an experienced musculoskeletal specialist.

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