What should I use, Doc, ice or heat?

I have this question asked of me almost daily. Patients are so confused about what to use on their injuries. Many times they guess wrong and it will add to the length of their disability.

Should I use ice, heat or both? How long should I apply the therapy? When should I change from one therapy to another?

First, you have to determine if the injury is acute or chronic. An acute injury is an injury that happened within the previous 48-72 hours. A chronic injury is one that has happened at least several days ago.

My advice for an acute injury is to start with ice. When in doubt, always use ice. You will never go wrong using ice. I always tell patients you never see a heating pad on a football field.

When the body experiences an injury such as a sprain, muscle pull, contusion or bruise, it responds with inflammation. Many times the body overresponds to the injury and too much inflammation goes into the injured area.

Applying ice to the area will cause the blood vessels to constrict, reducing the inflammation going to the injury. Ice also has an analgesic effect, which reduces pain to the injury.

I recommend using an ice gel pack, a bag of ice cubes or a bag of frozen peas. These will conform to the injured body part, spreading the cold equally. Place a cloth between your skin and the ice. This will protect your skin from frostbite.

Apply the ice for 15 to 20 minutes. You can reapply the ice after resting for an hour. Continue to apply the ice if the typical signs of inflammation continue: redness, swelling and heat.

Also, compress and elevate the area when possible.

I recommend heat for most chronic injuries or conditions, such as arthritis. With a chronic injury, you will have muscle spasm, muscle tightness and scar tissue.

Heat feels best. It causes the blood vessels to dilate, bringing in more blood to the area. This blood will bring fresh nutrients to help heal the injury.

I also recommend my patients use moist heat. If they have a heating pad at home, I ask them to use a moist, warm towel between them and the heating pad. They can also use a hot water bottle with a warm wet towel wrapped around it.

You should never use heat for more than 20-30 minutes. Using heat for an extended period can cause congestion to the injury, slowing the healing process and increasing the pain.

Do not fall asleep with a heating pad. I have seen second-degree burns as a result. The prolonged heat will cause a numbness in the skin and you will not feel the tissue burning.

I had one female patient with chronic lower-back pain. During my examination I noticed the skin on her lower back was discolored to a light brown. She told me she sits in her chair with a heating pad on while she watches TV or reads.

She uses her heating pad several hours per day. She had actually cooked her skin.

The good news is she responded to my care. She then stopped using her heating pad and her skin returned to a normal color. I joked with her that she had cooked herself to medium rare.

I will even recommend using heat for 10 minutes, followed by ice for 10 minutes, then resting for an hour.

This is an excellent way of transitioning from an acute to chronic condition.

Dr. Robert Lynch is a former president of the Maine Chiropractic Association and head of the Lynch Chiropractic Center in South Portland. “Staying in the Game” appears every other Thursday in the Press Herald.