Injury Management

Cold/Hot Packs – A Necessity for Any Injury!

Excellent for Natural Pain Relief, Reduced Inflammation, Faster Return to Movement and Faster Healing.

What is R.I.C.E. and why do you need it?

One of the most recommended icing techniques for reducing inflammation and treating minor injuries is R.I.C.E., an acronym for Rest, ICE, Compression and Elevation. It is best used for:

• pulled muscles
• sprained ligaments
• soft tissue injuries
• joint aches

Applying R.I.C.E. treatments will decrease:

• pain
• inflammation
• muscle spasms
• swelling
• tissue damage

How R.I.C.E. achieves this is by reducing blood flow from local vessels near the injury and decreasing fluid hemorrhaging which results from cell damage.

To administer R.I.C.E. use the following guidelines suggested by the American Academy of Orthopaedic Surgeons:

Rest

Stop using the injured body part immediately. If you feel pain when you move, this is your body sending a signal to decrease mobility of the injured area.

Ice

Apply an ice pack to the injured area, using a towel or cover to protect your skin from frostbite. The more conforming (adopting shape of body part) the ice pack is, the better, in order for the injury to receive maximum exposure to the treatment.

Compression

Use a pressure bandage or wrap over the ice pack to help reduce swelling. Never tighten the bandage or wrap to the point of cutting off blood flow. You should not feel pain or any tingly sensations while using compression.

Elevation

Raise or prop up the injured area so that it rests above the level of your heart to help prevent or limit swelling.

How long should ice be applied while practicing R.I.C.E. for it to be effective? There are four levels of cold felt by the skin:

1. coldness
2. a prickly or burning sensation
3. a feeling of aching pain
4. finally a lack of sensation or numbness

When the area feels numb, icing should be discontinued. The skin should return to normal body temperature before icing again. Usually numbness can be achieved in 10 to 20 minutes. Never apply ice for more than 30 minutes at a time or tissue damage may occur.

It is generally recommended to practice R.I.C.E. at intervals of 4 to 6 hours for up to 48 hours after an injury.

Ice Therapy Versus Heat Therapy

Ice

With any sprain, strain or bruise there is some bleeding into the underlying tissues. This may cause swelling, pain and 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 will:

• Reduce bleeding into the tissues
• Prevent or reduce swelling
• Reduce muscle spasm and pain
• Reduce pain by numbing the area and by limiting the effects of swelling which cause pain

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 aims change to restoring normal function. At this stage, the effects of ice can enhance other treatments such as exercise by reducing pain and muscle spasm. This then allows for better movement. If you have to do exercises as part of your treatment it can be useful to do them immediately after ice is removed when the area will still be a little numb or alternatively with ice in place. This reduces pain and makes movement around the injury more comfortable.

Heat

Do not use heat on a new injury! For example, soaking in a hot bath, or using heat lamps, hot water bottles, and deep heat creams are all not advisable. Applying heat will simply increase blood flow and make the problem worse.

When an injury is older than 48-72 hours (depending on the amount of inflammation present), heat can be applied in the form of heat pads, deep heat cream, hot water bottles or heat lamps. Heat causes the blood vessels to dilate (open wide) which brings more blood into the area. This optimizes the healing/rehabilitation environment in tissues through the influx of cells involved in tissue repair.

Additional effects of heat include :

• Relief from tension, muscle spasms or tightness in muscles
• Possible reduction of joint stiffness
• Possible pain relief
• Increased flexibility

There are a few considerations to keep in mind if heat is to be used:

• Heat applied to the skin should not be hot. Gentle warmth will suffice.
• There is the risk of burns and scalds if the heat applied is too intense. The skin must be checked at regular intervals.

Ice often gives better and longer lasting effects on the circulation than heat. The pain killing properties of ice are also deeper and longer lasting than heat.

Precautions When Using Heat and Ice

Do not use cold packs or heat:

• over areas of skin that are in poor condition
• over areas of skin with poor sensation to heat or cold
• over areas of the body with known poor circulation
• if you have diabetes
• in the presence of infection

Also, do not use ice packs:

• on the left shoulder if you have a heart condition
• around the front or side of the neck