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Ice and Heat Treatment for Injuries
Frequently Asked Questions

What is hydrotherapy?
What are some effects on soft tissue when applying ice?
What are some effects of heat?
Is heat or cold a better application after suffering a soft tissue injury?
How long should I apply ice and when is a good time to use heat?
What are the best methods for icing and applying heat?
Are there any precautions to take when using ice or heat?

What is hydrotherapy?
Hydrotherapy is the use of water in any form (solid, liquid, vapor), used internally or externally for the treatment of disease or injury. In general, there are two major categories of hydrotherapy treatment---heat, or thermotherapy; and, cold, or cryotherapy. ‘Combination hydrotherapy’ is a third category, where heat and cold are applied either in alternating sequence (contrast therapy), or simultaneously at two different body regions (zone therapy) (see below for application of).

What are some effects on soft tissue when applying ice?
1) It reduces swelling by causing the blood vessels to contract, thus pumping fluid away from the site of injury.
2) Cold is an analgesic or pain killer. It causes local numbness by reducing the sensory neuron impulses to the spinal cord and by decreasing muscle spasm.
3) Ice increases the circulation to the injury after it has been applied for 15 to 20 minutes---a result of vasoconstriction. After 15 minutes the blood flow to the tissues is reduced causing lack of oxygen. This triggers the nervous system to vasodilate or open the blood vessels and increase the flow of blood. Once the oxygen level moves up toward normal levels, vasoconstriction will return. Thus, swelling is kept to a minimum.

What are some effects of heat?
1) Heat helps relax the muscles and makes movement easier.
2) It increases the blood flow which helps to remove debris from the injury and can speed recovery.
3) Increases elasticity of ligaments and muscles.
4) Increases the formation of edema (pooling of fluids in tissue)

Is heat or cold a better application after suffering a soft tissue injury?
In cases of a recent injury (acute stage of healing), evidence shows that ICE is the treatment of choice. Do not use heat on a new injury. The heat will cause an increase in blood flow and swelling. While heat may feel good temporarily, it can actually increase pain and disability from an injury.

When an injury is older than 48-72 hours (subacute and maturation stages of healing), HEAT can be used as a means to reduce pain and spasm and helps relax the muscles and make movement easier. Ice can do many of the same things that heat does during this post-injury period. Cold will also break up spasm in muscles, reduce pain, and increase blood flow, as described above, while avoiding an increase in swelling.

Heat can also be used on any condition that benefits from an increase in circulation, relaxation, and improved extensibility of connective tissue.

How long should I apply ice and when is a good time to use heat?
An injured area often responds best to ice if used frequently. For it to be most effective, leave ice pack on at least 15 minutes (usually by then it will feel uncomfortable), remove for 15 minutes, then repeat for an hour or two. After 48-72 hours post-injury, heat can be applied.

What are the best methods for icing and applying heat?

Ice packs
Ice packs are the most efficient and effective method of application. A soft, flexible pack is preferred over a hard block of ice. It molds over a body part, while ice cubes give uneven cooling.

Soft packs may be purchased at any pharmacy or sporting goods store. To make a homemade soft pack, place water in a ziplock bag, leaving enough room for ice to expand. Add a small amount of rubbing alcohol (20-1 ratio). Place in the freezer until water becomes a slush pack. Remove and break up ice pack, making it soft and pliable.

No ice in the freezer? A bag of frozen peas or corn makes an easy and remarkably effective cold pack. Note: Be sure not to cook the peas for dinner at a later time! Refrozen food is a health hazard.

To apply:
1) Rub a small amount of oil over the area where the ice pack is to go (any oil can be used, even cooking oil). If the skin is broken or there are stitches in place, do not cover in oil but protect the area with a plastic bag. This will keep the wound from getting wet.
2) Wrap the cold pack in a thin towel and place on the skin (flannel or linen works great).
3) Check the color of the skin after 5 minutes. If it is bright pink or red remove the pack. If it is not pink, replace the bag for a further 5-10 minutes. Less time is needed for areas without significant body fat, such as the ankle, and more time for areas such as the thigh.
4) Leave ice on for 15 minutes. If ice is left on the skin for a longer period you run the risk of damaging the skin.

The danger in cold treatment is in overdoing it, because the skin (especially on a bony area such as the ankle) can suffer frostbite and possibly nerve damage. Please listen to your body!

Immersion baths
Immersion baths are very effective and quick cooling. Make an ice bath in a bowl and place foot, hand, or elbow in the bath. Larger body parts can be submerged in a tub filled with cold water.

Heat applications
Hot baths, hot water bottles and heating pads are good applications for heat. Heat should not be extremely hot. Water above 110° F is injurious to the skin. It breaks down tissue, and increases chance of infection.

Zone therapy
Zone therapy is the use of both heat and cold simultaneously at two different body regions. Zone therapy can be used for conditions such as headaches, nasal congestion, sprained ankles, etc.

Headaches: Place a cool compress on the head/neck, and place heat on the feet. The heat will help draw blood to that area while the cold will help constrict the blood vessels near the head. This helps take pressure off the head.

Nasal congestion: Place heat on head first. Then place cold to the head and heat to the feet.

Sprained ankle: Place heat in the inguinal (groin) or popliteal (behind knee) area and then place cold on the ankle.

Contrast therapy
Contrast therapy is the alternate application of heat and cold to the same body area. This type of therapy: 1) Facilitates edema (fluid) removal, by creating alternate vasodilation and vasoconstriction of the local blood vessels; and, 2) Enhances the healing process by bringing nutrient-rich blood into the area via vasodilation, and pushing waste-laden blood out of the injured tissue via vasoconstriction.

Contrast treatments are good to use in the post-injury phase, edema removal, or when uncertain of the readiness of the tissue for heat.

A full session of contrast therapy takes about 30 minutes. A general formula to follow looks like this:

7 minutes COLD
2 minutes of HEAT
5 minute of COLD
2 minutes of HEAT
5 minutes of COLD
2 minutes of HEAT
7 minutes of COLD

Miscellaneous Techniques

Steam and sauna – Duration 20 minutes, cold shower, rest or another 10-15 minutes in the sauna. Drink plenty of fluids throughout treatment. In the sauna, keep head lower than body to avoid drying out mucous membranes and put wet towel over head. Steam or sauna is not advised for persons who have suffered a stroke, people with heart conditions, high or low blood pressure, pregnancy, or tuberculosis.

Whirlpool bath – Duration 15-20 minutes. At least ½ hour before receiving a massage. Used for fractures and arthritis to decrease stiffness and deformity.

Compresses (local wet application) – Compresses can help reduce swelling after a sprain, reduce bleeding, and decrease pain. This method is also used over skin inflammations. Hot compresses relax muscles, dilate blood vessels, loosen joints, and are used in preparation to exercise and for chronic pain.

Are there any precautions to take when using ice or heat?
There are several conditions that may warrant using hydrotherapy. If you have any concerns, please check with your physician prior to applying heat or ice. The following conditions contraindicate the use of either heat or ice:

Malignancy
Cardiovascular disease (cold is contraindicated)
Circulatory impairment or tendency to hemorrhage
Skin lesions
Severe hypertension (high blood pressure)
Pregnancy (heat can be used with great caution---the core body temperature should never be raised above 102° F)
Active tuberculosis (heat is contraindicated)
Raynaud’s Syndrome (cold is contraindicated)
Diabetes (especially to hands or feet) (cold is contraindicated)
Any area where sensation is diminished or there is loss of feeling, i.e., frostbite (cold is contraindicated)

NOTE: The questions above are for your information only, and should be used as an aid in understanding the various benefits of hydrotherapy. They are not intended as a prescription for any condition or as a substitute for medical professional help.