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Health Answers

When to ice and heat an acute injury

By Courtney Humphries
June 7, 2010

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Q. When do you ice an injury and when do you heat it?

A. John Richmond, chairman of orthopedics at New England Baptist Hospital, says that an acute injury should always be iced, never heated, whether it’s a muscle strain, a twisted ankle, or pain around a joint. The ice will constrict blood flow in surrounding blood vessels, which reduces swelling at the injury site. The cold will also help to dampen pain. Apply an ice pack for 15 to 20 minutes, about four times daily. Always use ice after a physical activity rather than before.

Richmond says that commercial ice packs work well, including disposable packs that rely on a chemical reaction for instant cooling, or cold gel packs that can be kept in the freezer and reused. But a homemade ice pack will do the job equally well. “My personal favorite is a sack of frozen peas,’’ he says. He advises caution when applying a chemical ice pack to the skin, as they can get so cold they cause skin burns.

After a few days of icing, applying heat can help with the healing process for as long as needed. It reduces stiffness that occurs around an injury site and increases blood flow to healing muscles and joints. Richmond says that many people switch to heat too quickly, and recommends avoiding heat until three to five days after an injury. Any kind of heating pad will work, but be careful not to use excessive heat that can burn the skin. Richmond says that moist heat pads, though more expensive, offer the advantage of transferring heat deeper into tissues. Like ice packs, heating pads can be left on an injury for 15 or 20 minutes at a time; don’t leave a heating pad on the site while sleeping. Heat can also be helpful for chronic injuries, particularly before an activity, to loosen muscles and increase mobility.

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