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Ice or Heat; Hot or Cold 

 September 14, 2010

By  Dr. John Vilkelis

 

Many practitioners give their patients advice on using heat or cold therapies on different ailments and injuries.  How many of them give the wrong advice on ice or heat would surprise you.

How many of you have heard “You should ice for the first 48 – 72 hours then its heat after that” from some healthcare provider.  This is standard from many practitioners and it’s what they are taught in school.

Studies actually show that injuries in an acute state respond well to ice because you need to get the inflammation down which allows the joint or muscle to move more freely.  The studies also show that the same injuries respond well to moist heat after 72 hours after the swelling is going down if (and this is the big IF everyone ignores) you have immobilized the joint and are staying off it.  If you have injured your wrist or ankle it is relatively easy to stop using it.  Wrap it up, use crutches, whatever it takes.

BUT, what if you can’t stop using the joint or it’s not a severe injury and you’re content to limp around on it until it feels better?  The advice to switch to heat in this instance is completely wrong.

When you use the joint while there is inflammation in there you are irritating the soft tissue each time you use it.  In other words you are reinjuring the joint and keeping the injury in an acute stage.  You never get out of the first 48 – 72 hours.  Keep using the ice.  This is especially true of spinal injuries.  You don’t stop using your spine unless you are confined to bed (bed rest is the absolute worst thing you can do for back pain).

Remember to keep using ice if you are still using the joint.

By the way, the best way to ice is to completely submerge the injury in an ice bath with a lot of ice and some water.  Next best is to completely surround the joint with bags of real ice.  I don’t recommend using gel packs unless you have no alternative because they start to get warmer as soon as you put them on your body.  Real ice stays cold for a while.  I often tell my patients to ice for 20 minutes of each hour or to do it in 10 or 15 minute intervals (10 on, 10 off, etc).

I hope this post was helpful.  Please let me know what you think.  I would love to share you experience.

Dr. John Vilkelis


Dr. Vilkelis has been in private practice for over 27 years. He has a reputation for truly caring for his patients and goes the extra mile to make sure people get the help they need. He accepts patients of all ages and is eager to help you get well and stay healthy. Give him a call today at (914) 618-4330.

Dr. John G. Vilkelis

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