Ice or Heat?

Heat or Cold: The Eternal Question

by Bob Marley ATC, LAT, CSCS

How an injury is treated will determine how quickly an athlete may return to full activities. Choosing the appropriate modality at the right time can prevent complications and return an injured athlete to 100% as quickly and safely as possible. It is a common practice to use ice for the first 24 -72 hours following an injury, however, the big question is whether or when to switch to heat following an injury. By comparing the effects, uses and advantages of the two, and educated decision can be made by the Athletic Trainer, coach, or parent.

Cold therapy, or cryotherapy, causes several body responses including vasoconstriction, a decrease in the rate of chemical reactions involved in cellular metabolism, reduction in the velocity of impulses in peripheral nerves, reactive increases in blood flow, and an increase in muscular strength. Following the application of ice to the body, the immediate physiological response is constriction of the blood vessels, which significantly reduces blood flow to the injured area. Cold also acts to slow the rate of chemical reactions that occur as a part of tissue metabolism. A side effect of this diminished metabolic process is a reduced rate of scar formation. In addition to slowing the formation of normal metabolic by-products, which would usually stimulate vasodilatation, cold also acts to inhibit the release of histamine.

Following an injury, damaged cells stimulate the release of histamine, a potent vasodilator that greatly increases blood flow to an area. Cryotherapy has an additional valuable property in the treatment of an acute athletic injury -- it is an effective pain reliever. The exact mechanism of pain control is unknown but it is believed that the number of nerve impulses is slowed and reduced and the transmission of those impulses into the brain is interrupted.

Once the Ice is removed, the body responds by flooding the area with blood and bringing the tissue temperature back to a more normal level. This pouring of blood into the area brings above normal levels of oxygen and nutrients, a factor that is extremely important in the treatment of overuse injuries, in which the levels of tissue breakdown exceed those of tissue repair.

For those athletes whose high level of activity produces a chronic inflammatory condition in which the body is continually failing in its attempts to heal itself, regular cold applications can boost the healing process sufficiently to allow athletes to continue their high levels of activity. Finally, cold has the usual property of actually muscular strength. Some studies have shown that strength of the cooled muscle tissue began to exceed precooled or normal levels at 60 to 80 minutes following removal from the cold modality, and maintained remarkably high levels for up to 180 minutes.

Cold application methods include ice bags, reusable ice packs, ice baths, cold compression units and ice massage. Generally, cold should be applied for 5 - 20 minutes, not to exceed 30 minutes. Once the area is numb, the ice should be removed and any appropriate exercise initiated. Commercial cold packs should be used with caution because they can cause tissue damage (due to temperatures below freezing) and often times their ingredients are caustic to the skin. Cryotherapy is inexpensive, can be self-applied, is convenient, and can be done in conjunction with range of motion exercises. On the other hand, cold treatments can be uncomfortable and cause joint stiffness so strenuous activity should be avoided for 20 - 60 minutes following application. Please be aware that some athletes may be "allergic" to ice. These individuals will complain of pain out of proportion to the cold, formation of blisters, itching, and general skin irritations. If your athlete exhibits any of these symptoms after cryotherapy, please consult a physician for the best treatment options.

Continue to the Effects of Heat on the body.

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 10/24/2009 12:09:35 AM