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Ice and heat therapy

Ice therapy (cryotherapy) is the use of ice in the treatment of acute and chronic injuries.

The application of ice is an important step in the RICE (Rest, Ice, Compression, Elevation) protocol following acute injuries. Ice is the recommended treatment modality immediately after an injury for its ability to reduce inflammation and swelling in the affected area and for its pain relieving properties. Ice is effective because it causes a reaction in the body which inhibits the release of a chemical called acetylcholine. The low levels of acetylcholine allow muscles to relax and it reduces the amount of muscle spasm which eases pain. Swelling is reduced because ice causes the blood vessels to constrict. The reduced blood flow prevents and helps ease swelling. Ice also numbs the area affected by decreasing the rate at which nerves conduct. The resulting sensory loss (numbness) is a welcome relief from the acute injury pain.

The recommended dosage in the acute phase is to apply ice to the injured part for 10-20 minutes every two hours for the first 24 hours, reducing the dosage after the first day depending on how well the injury is healing.

Ice therapy can be used successfully to reduce swelling and pain in the following conditions:

  • Muscle spasm
  • Trigger point pain
  • Contusion (corked thigh)
  • Acute injuries and swelling including muscle strains and ligament sprains
  • Tendinopathies

There are various ways to apply ice. Most commonly, physiotherapists use reusable cold packs or crushed ice in bags with a damp layer of towel applied between the skin and the ice to prevent frostbite. Ice massage is also a popular treatment method amongst physiotherapists, particularly in the treatment of tendinopathies. Here water is frozen in a polystyrene cup and rubbed in a circular massage motion for 5-10 minutes directly onto the skin.

Superficial heat therapy is commonly used in physiotherapy practice in the non-acute injury phase (after first 72 hours of injury) as a pain relieving and muscle relaxing treatment modality. Superficial heat is effective in pain relief because it increases blood flow which warms the underlying muscles. The muscle warmth reduces muscle spasm, thus decreasing pain levels. The increased blood supply brought on with the application of heat helps in the re-circulation of inflammation and pain causing chemicals which will also assist in pain reduction.

The most common method physiotherapists use for applying superficial heat is the use of heat packs. These can be microwavable heat packs or heat packs that have been submerged in hot water in a hydrocollator kept at a constant temperature of 65 degrees Celsius. Either way, a layer of towel is applied between the skin and the heat pack to prevent burns.

Superficial heat therapy is beneficial in the treatment of:

  • Chronic pain such as chronic low back or neck pain
  • Chronic swelling
  • Muscle spasm
  • Chronic joint conditions such as osteoarthritis

With ice and heat therapy, your physiotherapist will first clear you of any contraindications, including circulatory problems and hot and cold hypersensitivity before commencing treatment.

A big advantage of ice and heat therapy is that both of these modalities are inexpensive and effective treatment techniques that you can continue to use at home for greater pain relief and improved rate of healing.


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