Q. I’ve had a variety of injuries playing sports. Sometimes doctors tell me to use ice, other times heat. Which is correct?

A. Both are actually correct. Both ice and heat are very effective in the treatment of both acute and chronic orthopaedic and sports medicine problems. Both affect circulation deep in your tissues, muscles and joints. I prefer ice for any acute injury where there is swelling. I do not tell athletes or patients to switch over to heat automatically after 48 hours but rather have them continue to use ice as long as there is swelling after an acute injury.

Ice reduces pain and minimizes swelling especially when combined with elevation of the injured part. In the training room we have cryotherapy units that actually pump cold compressed air through the use of a boot or sleeve to the injured area. Professionals such as athletic trainers or physical therapist actually can combine the use of heat and ice in the acute injury situation (contrast baths). When dealing with more chronic injuries I find that some patients do better with heat, and some with ice. Usually I prefer heat to help relax sore stiff muscles or to try to regain mobility, or even as part of a warm-up. Immediately following activity or sports, even in the chronic situation, I prefer ice.

When using heat or ice one must be careful of both frostbite and burns. This is especially true with freezer gel packs whose surface temperatures actually can get much colder then with regular ice. With ice I prefer a very thin small washcloth placed in cold water and rung out. This is placed over the injured part and the freezer pack or ice pack applied over that and held in place with an ace wrap. Direct ice massage can also be used and one easy way is to fill a styrofoam cup with water to the brim and place it in the freezer.

The insulated cup portion can be held while ice massage is placed to the injured body part. Heat can be used in either the dry or moist varieties and physical therapists and athletic trainers have ways of applying even deeper heat to your tissues. Ice should not be used longer than 30 minutes at a time and can be repeated every few hours. Heat can stay on longer. Individuals with impaired sensation (i.e. diabetics or nerve damage) must be especially careful with the use of ice or heat.