Use of Ice and Heat (Care of the Young Athlete)
Ice and heat are often used in treating
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
therapy: Ice packs, ice bath/ice whirlpool, ice massage. (See
“Options for applying ice.”)
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
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).
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.
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).
Bucket or tub with mixture
of ice and water
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).
Ice cube or frozen ice cup
(made by freezing water in a paper or Styrofoam cup)
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.
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