Should I Heat or Ice An injury?


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I often get this question as a physical therapist and the answer is...well, it depends.


An important part of an initial consultation is taking a full history of the injury to get a clear understanding of a timeline and a potential cause. In this blog we are specifically talking about a soft tissue injury such as a sprain of a tendon or ligament, tendonitis, strain of a muscle, bursitis and/or a contusion (bruising).


Giving your PT a timeline can help determine what stage of the injury you are working with. Each stage of rehabbing an injury requires different components for the healing to occur and eventually go onto the next stage. If you and your therapist can come up with a plan to create the best possible environment to tend the injury at hand, the healing time and return back to your goals will be smooth and seamless.


This is not medical advice specifically for you and your injury but a "loose guideline" that I tend to give my clients summed up in the table below.


Phase of Injury

Onset

Examples

Timeframe

Recommendations

Heat or Ice?

Acute

Severe, Sudden, Spontaneous pain (usually a mechanical component or post surgery)

Redness, Swelling, Bruising, Limited range of motion, Muscle weakness, Inability to weight bear

​0-4 days

P.E.A.C.E. Acronym >Protect--unload movement for 0-3 days >Elevate--limb above heart level >Avoid--anti-inflammatory medications >Compress--taping or strapping to reduce swelling >Educate--injury education & prognosis

Ice can used as an analgesic (helpful to use instead of anti-inflammatory medication)

Subacute

The repair & recovery phase after an acute injury. The tissue regeneration phase.

Lessening of above symptoms, improved range of motion, ability to tolerate more movement & load

4 days--6 weeks after acute injury

L.O.V.E. Acrynym Load--active movement and exercise highly encouraged Optimism--psychosocial factors influence pain Vascularization-cardiovascular exercise highly encouraged Exercise to reduce re-injury and restore strength, mobility, ect.

​Either heat, ice or none. Patient's preference

Chronic

​Tissue has healed and remodeled however a flair up/ inflammatory phase might occur

Dull achy pain, Nagging pain at rest, Little or no signs of inflammation

​6 weeks +

Daily Movement, Exercise using pain as a guide, Pain Education, Loading Tissue, Optimism

​Either heat, ice or none. Patient's preference


If you have been more familiar with the acronym R.I.C.E---rest, ice, compress, elevate, which is used for a soft tissue injury 24-48 hours after; the new research has now suggested using the acronym P.E.A.C.E & L.O.V.E---protect, elevate, avoid, compress, educate, load, optimism, vascularization & exercise.


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The problem with the acronym RICE was that it is only for very acute soft tissue injuries (only 24-48 hours after)...but what should you do after you've passed the acute phase of healing? That is why PEACE & LOVE was created by researchers Dubois and Esculier. PEACE should be used during acute injury phase and LOVE during the subacute injury phase.


Notice that ice or heat is not part of it. In the clinical setting, personally, I only use heat or ice for a patient's injury to provide an analgesic effect either before or after a treatment session for a few minutes. Research has shown that heat or ice do not provide any significant long term differences in pain levels, but for a short, temporary period, yes. The thermoreceptors or the nerves endings under our skin that identify temperature change are stimulated with cold or heat. When these receptors are stimulated they may temporarily "drown out the noise" of the pain symptoms allowing a moment of relief.



 

Before & After Pics of the New PT Studio in LIC!



✨5-31 50th Ave Long Island City, NY 11101✨


➡️Half block away from Vernon Blvd/Jackson Ave stop on 7 Train

➡️4 blocks from 21 Street Van Alst stop on G train

➡️1 stop from Grand Central







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