We often get asked what to do when injured. Do you use heat or ice as a first level treatment. This always creates a huge amount of discussion in professional circles as to whether ice is useful or not on an acute injury....
Ice is always your friend when injury strikes, and this is why.
When you injure a muscle Inflammation and swelling occur. They need to occur as the swelling supports the injured area, much like a bandage would, limiting movement. Inflammation is an increase in blood flow, which is important as it brings lots of useful things to the injury site to allow the healing process to start. A bit like a truck bringing building materials to a building site.
It does this by dilating (widening) the blood vessels to allow lots of blood to flow into the area, this also creates heat due to the increase in blood.
So inflammation is useful, without it you can't heal. But we want to control that inflammation so the materials get to the area to heal it; too much inflammation can delay healing. So to control it we use ice.
The ice helps to control the dilation of the blood vessels. We allow inflammation to occur, but control how much blood etc arrives. You don't want all your materials on site on day one of a build project, clogging up the roads etc.
In order to control that inflammation, not stop it, we ice for a max of 10mins per hour, it calms but doesn't freeze the area, allowing lots of healing to occur but not overloading the area and keeping the dilation of those blood vessels in check.
After a couple of days of regular icing the first stage of healing should be well under way and the area is ready for stage two - strengthening.
Ice helps with pain control
Pain is a real problem when tissues are damaged. When a muscle or tendon is hurt, the countless nerves that serve that muscle are also hurt and this results in pain.
Ice is very useful here as ice will numb the superficial tissues around the injury and this helps with pain relief. Ice can work almost as well as medicinal pain relief and in most injuries ice is all you need to help manage the pain, with the added benefits listed above.
Ice hasn't been shown to get deep enough into the muscle tissue to freeze the muscle itself, but it doesn't need to as numbing the area around the injury usually works well enough to stop the pain. As it doesn't get deep enough to freeze the muscle, it also can't cause any damage to the muscle, though superficial ice burns can be an issue, so always use a damp tea towel under the ice to protect the skin.
What type of ice is needed?
There are so many options when it comes to icing. Ice packs, Ice baths, Ice gel. so what works best?
When we ice, we are trying to move heat away from the skin, rather than putting cold into the tissue. This has the effect of removing heat and calming the area. The best way to remove heat from the surface is via water. Heat conducts better through water.
So the most effective, though not the most practical, way of cooling an area is in cold or icy water. So pop you ankle or wrist into a washing up bowl of cold water.
If you can't do that, then ice works well, it will melt and create a cold moisture area on the site. Next a gel pack will help to cool the area, but in a dryer form. You can improve this by putting a damp tea towel between the skin and the gel pack. Finally gels are the least affective, mostly because they create a chemical reaction that cools the skin, so not as effective as water based mediums.
Compression useful for swelling
Compression has been shown to be a great way to limit pain and swelling. Swelling in itself can be painful as it stretches the skin, which is full of nerve endings.
So strapping the area will again, help to limit that swelling, provide stability to the area and lower pain. So well worth having a go.
Why not heat?
There is so much confusion over whether to heat an inflamed joint, so let me explain why heat isn't a great place to start with an acute injury.
As we mentioned above, when an area is injured, the blood vessels dilate to bring blood rapidly into the area, to provide healing, clotting and clear damaged materials away.
If you were to put heat on it you would add to the inflammation. Heating the area, creates further dilation of the blood vessels, effectively inviting more materials onto your building site and slowing the healing process.
Heat is great for pain and stiffness associated with chronic injuries, or an over worked muscle, where there are no signs of inflammation. In this case the heat softens the muscle and encourages blood flow to clear any toxins away.
If the pain and swelling haven't subsided within a week, it is time to get some expert opinion on what you have done. If icing makes the pain worse, STOP and get it assessed properly to rule out fractures or broken bones.
The Reinge Clinic is a Physiotherapy, Sports Therapy, Sports Science clinic based in Kenilworth, Warwickshire. Take a look at our facebook page for our pain, injury and exercise advice posts and learn more about us on our website.
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