First 24hrs apply cold (Cryotherapy)
With any sprain, strain or bruise there is some bleeding into the underlying tissues. This may cause swelling and pain and can delay healing. Ice treatment may be used in both the immediate treatment of soft tissue injuries and in later rehabilitation.
During immediate treatment, the aim is to limit the body’s response to injury. Ice/cold will:
- Reduce bleeding into the tissues.
- Prevent or reduce swelling (inflammation).
- Reduce muscle pain and spasm.
- Reduce pain by numbing the area and by limiting the effects of swelling.
These effects all help to prevent the area from becoming stiff by reducing excess tissue fluid that gathers as a result of injury and inflammation.
In the later, or rehabilitation, phase of recovery the aim changes to restoring normal function. At this stage the effects of ice/ cold can enhance other treatments, such as exercise, by reducing pain and muscle spasm. This then allows better movement. If you are doing exercises as part of your treatment, it can be useful to apply an ice pack before exercise. This is so that after the ice pack is removed the area will still be a little numb. The exercises can also be done with the ice pack in place. This reduces pain and makes movement around the injury more comfortable.
Cold pack ideas
- Ice in a bag (can also be wrapped in a towel but less effective)
- Gel pack from the freezer
- wet towel kept in a freezer
- ice cup – a disposable cup containing water frozen, then peel back the cup and apply to area
- specifically designed boots
- cold water hose
Cold Application Duration
In the first 24hrs (acute stage) as immediately as possible apply cold for 10-30mins (depending on size and nature of injury). If using direct application of ice then this should be shortened to 3-10mins. This can be repeated every 2-3 hrs.
Be careful with open or bleeding wounds where the cold can effect coagulation – do not apply for more than 10mins.
Also be aware that in sensitive areas (eg face or groin) cold should also be applied for shorter periods (1-3mins).
After the first 48 hours, when bleeding should have stopped, the aim of treatment changes from restricting bleeding and swelling to getting the tissues remobilised with exercise and stretching. Ice helps with pain relief and relaxation of muscle tissue.
Heat causes the blood vessels to open wide (dilate). This brings more blood into the area thus bringing more oxygen and nutrients to the tissues to stimulate healing of damaged tissues. It has a direct soothing effect on sensory nerve endings and helps to relieve pain and spasm. It can also ease stiffness by making the tissues more supple.
Of course always test your heat pack to make sure it will not burn, gentle heating will suffice.
Heat pack ideas
- Gel pack from the microwave
- Hot water bottle
- heat lamps
- hot towels (but need to be replaced frequently) – moist heat is generally more effective than dry heat because it penetrates deeper into the muscles.
- specifically designed boots (soaked in hot water or microwaved)
- hot water hose
Cold & Heat Application Duration
24-48 hrs following trauma – First apply cold for 3 mins, then apply hot for 2 mins and repeat 3- 5 times. Always finish with cold!
48-72 hrs following trauma – First apply hot for 3 mins, then apply cold for 2 mins and repeat 3-5 times. Always finish with cold!