Friday, July 11, 2014
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Injury recovery: Heat or ice?

"Should I heat or ice my injury?" is one of the most common question Dr. Moore hears. She attempts to offer some guidelines in this update.

Injury recovery: Heat or ice?

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“What should I do? Heat or ice?” 

The amount of times I have been asked this could qualify for the Guinness Book of World Records. The most confusing part for people is that if you ask 20 different health care professionals, you will get 20 different answers because the literature varies on this—as do most people’s experiences and preferences on what to tell their patients. 

There are a few general rules that I tell my patients to follow as guidelines for when to use heat or ice.  The first—and this most, if not all healthcare practitioners will agree upon—is that 24-48 hours after sustaining an injury, ice should be applied.  This is where RICE (Rest, Ice, Compression and Elevation comes into play. After the 48 hours, we enter that gray area.

Generally, when it comes to applying ice continue to do so for up to two weeks following the injury. Ice is a wonder drug and most people scoff at how much it can really help an injury and can save you a trip to the doctor. Ice helps to decrease swelling. Normally when you have sustained an injury there is swelling. Whether you can see it with the naked eye or not, it is present.  Ice will help reduce the swelling and help decrease the pain. 

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Ice should be applied to the area for 15 minutes. You should make sure that there is a protective layer in between the ice and your skin as you do not want a burn. It is advisable to ice three times a day, morning, noon and evening. If you can only ice once then you should ice at night after the day is over and activities are completed. If you are able to elevate the area while icing, this is also advised. Persistent or worsening pain means you should seek medical help immediately.

When icing you do not need an ice pack purchased from a store. However, I know most people find taking ice cubes from the freezer and placing them on the injured area is uncomfortable.  Frozen peas work great as an ice pack. Here is a simple recipe for a do-it-yourself ice pack:

  1. Take 1-2 bottles of Palmolive dishwashing detergent (Palmolive works the best)
  2. Pour into a Ziploc bag
  3. Place entire Ziploc bag into another Ziploc bag (just in case the first one leaks)
  4. Place into the freezer
  5. Once it is cold you are ready to go!

Applying heat is generally for more chronic conditions or conditions that you have had for awhile. If you can describe your pain as stiff or sore that is generally when heat should be applied. If you come home from a day at work and your back and neck are stiff and sore then applying 15-20 minutes of heat will help relieve some of the soreness. This is different than if you bend over to pick something up and your back goes into spasm, then ice should be applied.

Just like with ice, you want to make sure that there is a protective layer between the heat source and your skin to avoid burning. Heat packs that plug into the wall are not advisable to use as they do not cool down and if you fall asleep while you are applying the heat, you could wind up with burns. A microwaveable or moist heat pack is advisable, as it will cool down after a while. If you fall asleep with it on your back, you need not worry about being burned. Here are some instructions on how to make your own heat pack:

  1. Take a clean sock
  2. Take a bag of uncooked rice
  3. Fill the sock with rice, allow some room for expansion and room to tie it off
  4. Tie it off with a piece of string or by knotting the sock itself.  Do not use anything metal as it will be going into the microwave.
  5. Heat in microwave for 1-2 minutes. 

These are meant to be general guidelines for the application of heat versus ice. But as I always tell people: when in doubt, ice. 


Read more Sports Doc for Sports Medicine and Fitness.

Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Kelly O'Shea Sports Medicine & Fitness Editor, Philly.com
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Robert Cabry, M.D. Team Physician for U.S. Figure Skating, Assoc. Team Physician for Drexel; Drexel Sports Medicine
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
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