Hot and Cold

This time of year as we adjust to the colder temperatures, we all want to slap on anything that heats us up. It feels goooood. The heat causes our blood vessels to open up, bringing more blood and even more warmth.  It causes our muscles to relax.  The heat is psychologically comforting and so we are probably getting some endorphins released. Many times heat is our friend, UNLESS, you have incurred a new injury.  Then is heat our friend? …not so much.

When you have a new injury, like a sprained ankle, or “slipped disk” (by the way– disks don’t slip), the way your body responds to the insult is an inflammatory response.  That initial response is important because it brings plugs to stop bleeding, cells to isolate the area, natural chemicals to clean up the damaged tissue, and the initial girding for healthy tissue to grow. The substances that make up the inflammatory soup are painful.  That’s probably the body’s way of telling us to pay attention to, and protect the injured area.  That’s also why, sometimes, a new injury doesn’t hurt until hours to a day later, because of the progression of the inflammatory response.  Hence, a little inflammation is good.  A lot of inflammation is not good.  Not only is it more painful, but the same natural chemicals that clean up the damaged tissue, can also attack new healthy tissue or even engulf established healthy tissue and delay healing.

Therefore, if you put heat on a new injury, the same mechanism that causes your blood vessels to widen and bring more blood, also can bring more inflammation with more pain causing chemicals and tissue eating cells.  Slapping on a hot pack to a new injury has just magnified your problem. Whoops.

Ice is the answer to your twisted ankle or your back that “just went out”.  The ice slows down and minimizes the inflammatory response, by initially reducing blood flow, and impeding the inflammation from spreading farther than necessary.  Ice also affects nerve conduction, so by icing you are preventing the nerve endings from communicating the pain to your brain.  Ice is an excellent, “natural,” “holistic,” pain reliever.  Ice reduces the elasticity of the tissues of your body.  A minor, unwanted effect of ice (other than making you cold), is it makes the region stiffer.

When a person comes to physical therapy and asks me, the physical therapist, what’s better, I tell the person this- If your primary complaint is stiffness, not pain, apply heat.  If it’s more painful than stiff, apply ice. Stiff? Hot pack. Pain? Cold Pack.  IF IT’S THE FIRST 3 DAYS of your injury, then ABSOLUTELY APPLY ICE! NOT HEAT!  Don’t bother with alternating hot pack/cold pack.  Stick with the tried and true R.I.C.E – Rest Ice, Compress, Elevate.

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