Thursday, June 20, 2013

Should I use ICE or HEAT?


is a question that is brought up many times in the clinic. SO, we will try to simplify things to better assist you. Here we go...

1) HEAT is often used when you have an acute injury with inflammation. 

  * Inflammation, swelling: The ice is used to bring down the swelling as it will   shrink the blood
     vessels. General rule of thumb is 20 minutes of ice/ 2 hr's of off time. However, many people
     I see ice, will use thick towels where the sensation of "cold" doesn't even penetrate the affected
     area during that 20 minutes. I prefer to use "ice" not an ice pack,...if at all possible, and I prefer
     to have it in a freezer bag or a bag that your local grocer uses to put the ice in......... This allows
     ice to penetrate very quickly.

CBA(I)N: Cold>Burning>Achy>(Intense burning)>Numbness. CBAN is the mnemonic used, but the intruduction of Intense burning has been added as a phase between Achy and Numbness.
These are the 4 (5) stages of COLD. Many patients never get to that feeling in 20 minutes. Sometimes it takes 30-40 minutes for this to occur. During acute injuries I have put a patient with ice for 30 minutes,...adjust them,...have them immediately ice again,... then follow it up with a second adjustment.......and guess what?.......I'll ice them a 3rd time,....followed by their 3rd adjustment. What? Really?...Yes, during an acute injury that adjustment will not hold during a first and often second adjustment. And it definitely won't hold without an anti-inflammatory (ice).

2) Chronic conditions: pain recurs. Never seems to go away. IF THERE ISN'T ANY INFLAMMATION?>>>>>>> HEAT.

3) Exacerbating pain: Pain comes,goes away for a period of time, returns.  HEAT.

How long should one heat? 10-20 minutes of a heat pack. Many types of home remedies for heat. But, please don't put ointment on for heat? That is a superficial method of heat and a lazy man's way of using heat. Why not use a heating pad or a wet towel? Wet towel the heat is intense very early on, but the heat dies out quickly and it often requires assistance to have repeated switching of towels for a 10 minute period of time. Put some hot water in the heating pad, and wrap in a towel, and place on affected area.........PERFECT. Achieve several things here. Increasing blood flow to affected area, loosen muscles and affected ligaments.  Oh,...don't fall asleep with heat applied. We don't feel like having burned patients.

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