Use of Ice and Heat (Care of the Young Athlete)

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Ice and heat are often used in treating

General comments

  • Icing may be used along with
    compression, elevation, bracing, and/or support when treating acute

  • Nonsteroidal anti-inflammatory drugs
    (NSAIDs) can produce a similar effect to icing. However, they may delay
    healing with acute injuries (like sprains, strains, and fractures). If
    your doctor recommends medicine, make sure you are aware of the right
    dosage and when to take it, and if there are any side effects.

  • The use of ice and heat is just one part
    of a treatment program. Even if symptoms are relieved, there is usually
    a need for exercises to restore flexibility and joint motion, strength,
    general fitness, and sport-specific skills.

Use of ice

  • Effects of ice: Decreases
    circulation, metabolic activity, and inflammation and numbs the

  • Benefits of ice: Decreases
    pain, swelling, inflammation, and muscle spasm/cramping. Best used after
    exercise or after pain-producing activity.

  • Risks of ice: Prolonged use
    can cause frostbite.

  • Methods for applying cold
    Ice packs, ice bath/ice whirlpool, ice massage. (See
    “Options for applying ice.”)

When not to use ice

  • Immediately before physical

  • If area of icing is numb

  • When the pain or swelling involves a
    nerve (such as the ulnar nerve or “funny bone”)

  • If the athlete has sympathetic
    dysfunction (an abnormality of nerves that control blood flow and
    sweat gland activity)

  • If the athlete has vascular disease
    (such as poor circulation due to blood loss, blood vessel injury,
    compartment syndrome, vasculitis, blood clots, or Raynaud

  • If there is skin compromise (such as
    an open wound; a wound that has not healed; skin that is stretched,
    blistered, burned, or thin)

  • If the athlete has cold
    hypersensitivity, including cold-induced urticaria (hives from

How long to use ice

  • Two to 3 times per day (minimum); up
    to once per hour.

  • Duration varies with technique;
    usually 20 to 30 minutes per session. (See “Options for
    applying ice.”)

  • Ice may continue to be useful in
    treatment as long as there is pain, swelling, inflammation, or
    spasm. There is no need to switch to heat after 48 hours or
    alternate between ice and heat.

Options for applying ice

1. Ice packs are best for icing
larger areas of pain, swelling, or spasm (like a swollen knee, deep thigh
bruise, muscle strain, shoulder tendonitis, or neck or back spasm).

  • Materials

    • Small cubes or crushed
      ice in plastic bag.

    • Bag of frozen vegetables
      (such as frozen peas).

    • Reusable commercial ice
      pack or circulating “cryocuff” (made
      specifically for therapeutic icing). Do not use blue ice
      packs directly on the skin; they are colder than frozen
      water and can cause frostbite.

  • Method

  • Place on the affected area for at
    least 20 minutes per session. Hold in place with a towel, elastic
    wrap, or shrink-wrap.

2. Ice bath/ice whirlpool is
used to reduce swelling in peripheral joints (such as with ankle sprain,
wrist sprain, or severe shin splints).

  • Materials

    • Bucket or tub with mixture
      of ice and water

  • Method

    Immerse affected area for 20 to 30
    minutes per session. Do not use an ice bath if there is an open
    wound, bleeding, or a skin infection.

3. Ice massage is used to
reduce superficial, well-localized inflammation (for example, tendonitis of
the hand, wrist, or elbow; heel or elbow bursitis; ganglion cyst;
apophysitis; or irritation of a growth plate).

  • Materials

    • Ice cube or frozen ice cup
      (made by freezing water in a paper or Styrofoam cup)

  • Method

    Rub ice in a circular pattern over
    the affected region for 8 to 10 minutes per session.

Use of heat

  • Effects of heat: Increases
    circulation, metabolic activity, and inflammation.

  • Benefits of heat: Improves
    compliance of soft tissues; relieves pain and spasm. Heat is most useful
    in warming up stiff or scarred soft tissues before stretching or
    exercise; heat may also be useful in relieving pain or spasm associated
    with neck or back injuries.

  • Risks of heat: May increase
    swelling and inflammation; using heat for too long or at temperatures
    that are too high can cause burns.

  • Methods for applying heat:
    Hot packs, hydrocollator; hot bath/whirlpool.

When not to use heat

  • After physical activity

  • If the area is numb

  • If there is an open wound or

  • Immediately after an acute

  • If body temperature is elevated from
    fever or heat stress