If we were to sprain an ankle, most of us would know to put ice on it. When it comes to back injuries there seems to be some confusion over whether to apply hot or cold. It’s a question I deal with daily and it’s something I address with my patients. So, what’s best to use and when? The rule of thumb is when an injury is new (acute), it gets ice. When it’s older than a few days (no longer acute), it gets heat. This is true with injuries involving joints, like sprains and strains. Now, there are exceptions. Textbook speaking, ice is good for 24 to 48 hours. From my experience I find that to stop using ice after 48 hours is usually premature. I usually reccommend several days beyond the 1 or 2, which is standard. Another day or two can’t hurt. However beginning heat too soon may make matters worse.
It’s best to get ice on an injury as soon as possible. It reduces swelling and numbs the pain. This is what we want with a new injury, but it’s effects usually don’t last more than a few days. When heat is applied it opens the blood vessels and promotes healing of the tissues.
A very important rule to using ice is, never take anything out of the freezer and keep it directly on the bare skin. There is nearly a 100 percent chance that you will get frostbite and you don’t need that on top of an already injured joint. Whether it’s ice cubes in a plastic bag or a sack of frozen peas there should always be at least one layer of fabric between the ice and the skin. It stays on for 20 minutes, then it comes off for 20 minutes. This cycle can be repeated as often as needed. Heat also needs a layer of material between the skin and the heat source. At least one layer of terrycloth towell works just fine. There are many ways to apply heat. Moist heat penetrates more deeply than dry. That includes soaking in water. And again, 20 minutes on and then 20 minutes off. If you use a heating pad, keep it on a low setting and don’t get in a position where you might fall asleep on it. As we age, our ability to judge how much heat we are getting is somewhat impared so we always want to go easy.
Bottom line is if you still can’t decide what to use, think ice first. You’ll seldom go wrong.
