Ice is the appropriate and effective therapy immediately post-injury and for the first 48 hours. Ice is used during the first 48 hours to slow down the blood flowing into an injured area thereby reducing the amount of blood pooling into the area (swelling).
The goal of the first stage of rehabilitation after an injury is physiological containment of the damaged area. Depending on the type and location of the injury, a number of types of cryotherapy can be used during the first stage including ice pack, ice immersion, cold whirlpool, chemical packs, and even frozen peas (good to keep in the freezer as they contour effectively to an area).
When using cold therapy, care must be taken to ensure that there is no damage to the skin or allergic reaction to the ice. Ice should not be placed directly on the skin. A barrier should be used (paper towel, washcloth) to protect the underlying skin from getting too cold.
How Hot/Cold Therapy Works
Once the swelling has stopped increasing (usually at the 48 hour mark, but may vary depending on the severity of the injury), a combination of hold and cold therapies can then be applied to help reduce the swelling that has accumulated. The hot and cold therapies work together as a type of physiological pump to assist in moving the blood out of the area.
The cold therapies reduce circulation to an area (vasoconstriction) while the hot therapies increase circulation to an area (vasodilation). The alternating cold and hot therapies act together to pump the extra fluid out of the injured area.
The key is in the combination of the cold and hot therapies. Hot/cold therapies are safe for injuries of the extremities (foot, ankle, wrist, hand) and not designed for full body immersion.
The general rule is to always begin and end the treatment session with a cold therapy. In between each cold therapy is a hot therapy. A typical hot/cold treatment would include three ice therapies and two hot therapies. The time for each cold or hot treatment is three to five minutes with a total treatment time of fifteen to twenty-five minutes.
Combinations of Hot/Cold Therapy
There are many variations in the types of cryotherapy and thermotherapy that can be used in hot/cold therapy. Possible combinations include:
- Ice pack/hydrocollator
- Cold whirlpool/warm whirlpool
- Ice immersion/warm bath
- Frozen peas/microwave heat pack
- Ice pack/jacuzzi
Care must be taken not to use temperatures that exceed 100 degrees for the heat portion of the treatments. The thermotherapy does not have to be too hot to be effective when used in combination with a cold therapy.
Hot/cold therapy can be performed once or twice a day beginning on the third day post-injury or when the swelling has stabilized. This therapy can be continued as long as necessary until the swelling is gone.
Contraindications of Thermotherapy
It is important to note that heat therapy should never be used immediately post-injury. Heat increases circulation to an area. There may be multiple small and large torn blood vessels in and around an injured area. Applying heat will increase the blood flow to the area allowing the blood to flow freely from torn blood vessels into surrounding tissue. This can significantly increase the swelling in a new injury.
Terry Zeigler - Educating through writing with over twenty-five years of experience as a Kinesiology Professor and Certified Athletic Trainer.
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