The most current ideas regarding choice of temperature therapy from the American College of Sports Physicians:
Heat feels good, softens tissues, brings blood into the area and provides a womb-like soothing sensation.
Ice, on the other hand, seems jarring by comparison. It’s cold, hardens tissues, and is anything BUT soothing.
The choice of Ice versus Heat therapy is not decided by what feels better when applied, but should depend on the timing of the injury. Current thinking is that the first seventy-two hours after a new/acute injury, nothing but ice should be used. Beyond this the opinions very, but most practitioners believe for the first one to two weeks after a new injury, “Ice is the most important” and keep the heat to a minimum if its used at all.
“Contrast Therapy” can start from two weeks to a month after onset of a new injury. In my San Francisco Chiropractor practice I find that patients often misunderstand this concept. The correct way to use contrast therapy is ten minutes of Heat, followed by alternating one-minute doses of Ice, Heat, Ice, Heat, Ice, Heat, Ice, Heat, and ending with Ice. end with ice.
The simplified version of Contrast Therapy is ten minutes of heat followed by five minutes of ice but this doesn’t create the pumping action as the alternating method.
When we apply ice we are trying to create, “The Hunting-Lewis Reaction”. In school we remembered this with the acronym C-BAN which stands for cold, burning, aching, numb. These are the four phases of the Hunting-Lewis Reaction and are due to alternating vaso-constriction and vaso-dilation.
Cold due to vaso-constriction, Burning as warm blood flows into the area due to vaso-dilation, aching due to vaso-constriction and finally, the desired effect, Numb, which is the ultimate analgesic effect of Ice therapy. These four phases create a pumping action in the immediate area which has more than one therapeutic effect. Pain relief, removing waste products from the cells, and decreasing swelling.
How I help my patients remember the proper icing protocol is “Ice Ice Baby”. Everyone remembers that song and what I want them to remember from this is the number two. Twenty minutes of ice, two hours between applications. This is to allow the tissues to warm back up prior to the next application.
One can ice two different area (If there are more than one area of pain or injury.) for instance you can ice a thigh and low back one after the other.
Where people often misunderstand me is they think they have to ice EVERY two hours. No not the case. Icing once in a day isn’t enough however, try to ice three to four times over the course of your day.
People have a preference one way or another but I prefer ice packs over ice in a baggie. Ice packs are not quite as cold as raw ice, and they stay cold only for about twenty minutes, which is the appropriate length of time. Don’t place an ice pack right on the skin, it can actually cause a burn. Have a towel or at least a T-shirt between the ice and your skin.
I hope this sheds some light on the controversy. Now get some ice !