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March 25, 2014
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Should I use ice or heat for my injury?  This is one of the most common questions I get in my practice.  The answer is "it depends".   Both can be beneficial.  For most conditions and injuries I see in my practice the answer is ice.  The general rule is to use ice for injuries within the first 24 hours and for injuries that continue to produce pain and swelling.  Most injuries to the lower extremity are being "re-injured" all day long as we walk on them.   Therefore, icing the area is effective after activity and again at the end of the day.  I  recommend utilizing an ice pack (frozen peas or corn work well too) for about 15 minutes at a time.  It is generally safe to ice an area for 15 minutes per hour.  A paper towel or similar material should first be placed on the skin so the icepack is not in direct contact with the body. Some people like to soak their feet in ice water.  I do not recommend this due to the risk of frostbite.  It is crucial to ice the area immediately following an injury.   A certain amount of swelling is ok because that is how the body brings the proper cells and nutrients to the area that are required to heal.   However,  our body tends to overreact and excessive swelling will add to the pain and time it takes to heal.  The icing works by causing the small blood vessels to constrict and limit the fluids moving into the area.   Icing also has a numbing effect on the nerves, which is welcome when you are in pain.

  Heat has the effect of relaxing muscles and is generally used in postural muscles, such as the lower back.  Heat is also often helpful in easing arthritic joints.  Heat serves as a vasodilator.   This means it opens the small blood vessels.  Extra blood flow is helpful to an arthritic joint and can help temporarily increase the range of motion.  Heat alone should not be used in acute injuries because the dilating of the blood vessels will increase the swelling further.  Moist heat is most effective and there are many heating pads available today.  Usually applying the heating pad for  20 to 30 minutes is ideal.   One needs to be careful not to make the pad too hot and risk a burn.   Falling asleep while a heating pad is on can be dangerous too.

There is a treatment utilized on athletes that need swelling to an extremity reduced quickly called contrast baths.  It involves alternating between soaking the injured limb in warm and cold water baths.  This works by forcing fluid out to the area by alternately constricting and dilating the blood vessels.  The extremity is in each bath for 5 to 10 minutes and then switched to the other bath.   Total treatment time is 45 minutes.   This technique is best left to trained professionals.