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Ken Breath, PT, ATC, LAT

Q: I am confused when I should use ice or heat on an injury? Also, cryotherapy tanks and immersion seem to be a new trend. Is that something I should be doing?

A: Ice is better if your goal is pain control, because cold reduces swelling and tissue damage by causing blood vessels to constrict. New research1 is showing that the optimum time for ice or cryotherapy, which simulates a very cold environment, is within the first six hours of injury. Icing too long can actually lead to muscle damage and delayed recovery because healing factors and chemicals cannot get through restricted vessels. The same research1 has also shown that rather than enhance the recovery of athletes, cryotherapy can delay recovery due to the extreme cold properties of this type of treatment. However different studies vary, so you should decided if cryotherapy is right for you.

The ideal time to ice an injury is around five minutes; anything more than that can cause muscle damage or slower recovery because of the delay in blood flow returning to normal. Tissue that’s damaged requires some inflammation to heal, recover muscle cells and regenerate soft tissue. Icing the area too long will restrict that healing process. Also never put ice directly on your skin; use a cloth or some kind of barrier.

Heat is better when the symptoms are tightness, stiffness or a muscle spasm. Heat should never be used on acute injuries like recent falls or trauma with signs of obvious swelling and bruising.Heat will increase blood flow and reduce the spasms in the muscle. Moist heat, such as a warm heating pad available at most pharmacies, works best. Apply heat for a maximum of 10-15 minutes.

Ultimately, movement, exercise and analgesics (pain medications) as needed will help heal most injuries.

1“Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?” JEM, 2008; Feb. 25; 65–68

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Ken Breath, PT, ATC, LAT is Manager of Motorsports Outreach, Head Physical Therapist and Athletic Trainer for Joe Gibbs Racing and a Physical Therapy Consultant for Davidson College. He also sees patients at the OrthoCarolina Huntersville location.


July 19, 2016

Good question. Very common. Not doing crunches with osteoporosis is a good thing. Too compressive on the spine and since there are better alternatives to crunches it is better not to do them. Twisting exercises per se are not bad and in fact in some cases may be needed so as to not lose range of motion of the spine. They just can’t be forced. Aerobic, water aerobics are great for cardiopulmonary fitness and are safe for osteoporosis. The medical research shows that resistance weight training with a focus on forearms, spine and hips is a good thing but it would be a good idea to consult a physical therapist or trainer for specific guidelines for exercise. Yoga can be good for flexibility but none of the stretching postures need to be forced. All postures are gently performed. Thanks for asking. I hope this helps.
- OrthoCarolina

July 18, 2016

I have osteoporosis. I am very active in the gym. I know not to do twisting exercises and crunches. Anything else I need to be aware of? How about yoga, aerobics, water aerobics, etc.?
- Patti Smith