Use
of Hot and Cold
One of the most commonly asked questions in the clinic is “should
I use hot or cold?” While it seems to be a simple question, the
choice made can significantly affect the outcome of an injury. The individual
merits of hot and cold are important when considering the desired outcome
of the application of each modality. The application of heat increases
the blood flow to an area resulting in the removal of waste products.
It will also enhance the pliability of the tissue to which it is applied.
However, if applied to an acute injury, it may increase the congestion
or swelling that often accompanies the injury. The application of ice,
in this latter instance is the treatment of choice as it decreases the
inflammation in the area and ultimately increases the circulation as the
body resists frostbite. This increase in circulation will assist with
the removal of the waste products of injury.
Ice should always be used for the first 72 hours following an injury or any time there is inflammation. Inflammation presents as redness, swelling, heat, pain and loss of function. A mild heat can be applied after 72 hours providing the symptoms of acute inflammation have subsided. Contrasting hot and cold application is another option after 72 hours, making use of the properties of vascular dilation and constriction respectively for waste removal. This is particularly helpful with ankle and hand injuries.
Ice should be applied until the skin reddens which tends to be after15
or 20 minutes. Ice should not be applied again until the skin returns
to normal temperature and sensation. Heat traditionally can be applied
for a slightly longer time,
30 minutes, but should not be too hot. Ideally, the area of skin to which
heat or cold is applied should be tested initially for normal sensation
to prevent the occurrence of frostbite or blistering from burns.
To gain the desired effect, the application of moist, as opposed to dry,
heat or cold is the most effective means of altering the body temperature.
Moisture helps the heat or cold penetrate. Wrap a slightly dampened towel
around a malleable hot or ice pack and secure to the injured area with
mild compression for the appropriate amount of time.