Fire and Ice

Did you know that both heat and cold can be used therapeutically? The secret is when to use what.


WHEN TO USE: Cold therapy can be used in both acute and chronic injuries. In acute injury, use it as soon as possible, ideally immediately after injury. In chronic injury or pain, this is reserved for use after activity. For example, in chronic back pain sufferers, it is used after a long day at the office or discomfort after a workout to reduce the metabolic rate of the tissue thus easing pain and tissue soreness.

To get best results, apply it using a part-conforming pack. Custom-made gel packs are also good but are relatively more expensive. A cheaper option is to use a bag of frozen peas or crushed ice in a plastic bag. Wrap this with a thin towel. The Good Morning towel is a good option.

HOW IT WORKS: In fresh (acute) injuries, cold therapy helps to reduce swelling and pain. It also reduces the potential for further injury to damaged tissue (reduces the metabolic rate and secondary injury). When used in chronic injuries it plays a role in relieving overuse pain.

WHAT TO DO: Apply the pack over the area for 20 minutes. In acute injuries, this is best repeated every two hours for the first 24 to 48 hours.


WHEN TO USE: For acute injury, this should never be used immediately after injury. Use is initiated once the acute inflammation has subsided (about 72 hours) and as a method to increase flexibility prior to rehabilitation exercises. In chronic pain, it is used to increase flexibility and reduce stiffness felt after a period of inactivity or prior to exercise.

Stiffness and discomfort after awaking from sleep also usually requires the use of heat.

HOW IT WORKS: Superficial heat increases flexibility of tendon and ligaments. It is also useful to reduce muscle spasm and stiffness. It does this by increasing blood flow and metabolism.

WHAT TO DO: Apply a warm pack (a moist towel is better than a dry one) to the treated part. The usual time for application is 15 to 20 minutes. The temperature should be 40-45°C.

Be careful

• Always be mindful that both cold and warm can cause skin injury.

• Redness of skin, which is not blanching to pressure, should alert one to the possibility of skin vascular compromise.

• Use it with caution in patients with possible peripheral vascular disease, like diabetes, Raynaud's disease or cold initiated hematological issue.

The writer is an orthopaedic, sports injury and trauma surgeon at Columbia Asia Hospital-Bukit Rimau