The hot and cold approach to injuries

We know that when we see bruising and swelling, it’s a good idea to apply ice to the injured area and if possible follow the RICE approach — Rest, Ice, Compression, and Elevation. In other words, raise the effected part of your body, apply ice and pressure to the injury, and do nothing for as long as possible!

But sometimes after an injury there’s nothing to see on the surface and we’re unaware that the muscles underneath have been bruised. Classic examples are when you have a very stiff neck — you feel that you must have jarred it and you can’t turn your head properly — or you’re aware of pain at the front of a shoulder. Dogs who yank their leads are very adept at inflicting this particular injury on their owners — see our case studies for an example!

However, heat also has a key role to play and the secret lies in knowing when to go hot and when to go cold.

OLYMPUS DIGITAL CAMERACold therapy slows down the blood flow to the injury, so reducing any swelling, inflammation and pain, and — as a rough rule of thumb — if the injury happened within the past 72 hours, you should apply ice. You can use cubes or a packet of frozen peas, or special gel packs, but whatever your choice never apply direct to the skin — wrap a towel around the ice first. The process should be soothing and you must stop immediately if there’s any pain or throbbing.

For areas that are difficult to reach, try a cooling strip like Kool ‘n’ Soothe, which is actually designed for children who are running a temperature! These can be stuck directly on the skin and directly over the source of the pain and will generally have a calming effect. They’re particularly good for the shoulders and neck where it’s difficult to apply ice and keep it in place, but — as with conventional ice therapies — should only be used for 20 minutes at a time with an hour’s gap between treatments. Cooling strips also work well with ankles, but go carefully as this area may also need some of the R, C, and E in RICE!

Heat takes over when the injury is more than 72 hours old — that is, once it’s becoming (or has become) chronic. It opens the blood vessels, so increasing the blood flow, relaxing muscles and alleviating pain. This approach works particularly well with lower back pain and can be delivered using a nicely pliable gel pack or a wheat bag which you heat up in the microwave. (A good, old-fashioned hot water bottle also does the job!) As with ice, don’t apply direct to the skin, don’t apply for more than 20 minutes at a time, leave an hour’s gap between treatments, and never use heat if there is swelling or bruising or no feeling in the affected area.

For more chronic back pain, heat wraps such as the Thermacare range are very effective and allow you to keep moving while benefiting from heat therapy. They can be kept on for hours at a time, but are for one use only — once you take them off, the heat is lost.

A further option is contrast bathing — or hydrotherapy — which is good for ‘nervy’ pain. Here you apply ice, then heat, then ice again in rapid succession. Again you can use ice cubes or gel packs (wrapped in a towel) for the cold therapy, and gel packs, wheat bags or a hot water bottle to apply heat. The smaller and more pliable the devices, the easier they will be to use. Cooling strips and heat wraps obviously won’t work here, though!

You also need a clock or watch at hand to time the sessions, which should be as follows:

1. Ice for 3-5 minutes

2. Heat for 3-5 minutes

3. Ice for 3-5 minutes

Only do this once a day and for a maximum of two days. If there’s no relief, then you must get your injury properly checked by your GP or explore an alternative therapeutic treatment such as clinical massage.