Heat or Ice (RICER)
When treating musculoskeletal injuries heat and icing (RICER) play very important but very different roles in recovery. With so many athletes and individuals getting it wrong, it is vital to learn what to use and when, so you can avoid further damage.
When to use Heat or Ice
ICE: Use ice immediately after sustaining an acute injury, such as a sprain. Ice should also be used when you've re-aggravated a chronic injury, such as plantar fasciitis or shin splints. An ice bath can also help with muscle recovery after running a marathon or long-training run.
Heat: Heat should be used on chronic injuries such as tendonosis (i.e. injuries that have been present for over a month without improvement but that has not become worse within the last 1- 2 weeks), or on "tense" muscles to help them relax.
Heat: Heat should be used on chronic injuries such as tendonosis (i.e. injuries that have been present for over a month without improvement but that has not become worse within the last 1- 2 weeks), or on "tense" muscles to help them relax.
Heating
Heat treatments should be used for chronic conditions to help stimulate blood flow to the area and to help relax and loosen the local tissues and to promote healing. Heat treatments may be used for chronic conditions, such as Achilles tendonosis or plantar fasciiosis, before participating in activities but never after activity or on a newly injured area.
Heating of an area can be accomplished using a heating pad, wheat bag or even a hot, wet towel or hot water bottle. When using heat treatments, be very careful to avoid burns.
Heat is useful for:
Pain relief (but not in acute inflammation or in inflammatory diseases)
Promotion of relaxation.
Increase joint range of motion / decrease stiffness
Reduction of muscle spasm.
Promotion of healing.
Prelude to passive mobilization and exercise.
Heat should be avoided for:
- Acute inflammation or injury -ie recent sprains or strains as it can increase oedema and bleeding in the are
- Acute Rheumatoid Arthritis
- Over an area of recent or potential haemorrhage (bleeding)
- Impaired circulation or thrombophlebitis
- Chronic venous insufficiency / Lymphoedema.
- Over or near malignant tissue
- People with impaired sensation, mentation and those with neuropathy such as caused by diabetes.
- Dermatological anomalies.
- Extremes of age.
- Over open wounds
- On areas of metal implants
Heating of an area can be accomplished using a heating pad, wheat bag or even a hot, wet towel or hot water bottle. When using heat treatments, be very careful to avoid burns.
Heat is useful for:
Pain relief (but not in acute inflammation or in inflammatory diseases)
Promotion of relaxation.
Increase joint range of motion / decrease stiffness
Reduction of muscle spasm.
Promotion of healing.
Prelude to passive mobilization and exercise.
Heat should be avoided for:
- Acute inflammation or injury -ie recent sprains or strains as it can increase oedema and bleeding in the are
- Acute Rheumatoid Arthritis
- Over an area of recent or potential haemorrhage (bleeding)
- Impaired circulation or thrombophlebitis
- Chronic venous insufficiency / Lymphoedema.
- Over or near malignant tissue
- People with impaired sensation, mentation and those with neuropathy such as caused by diabetes.
- Dermatological anomalies.
- Extremes of age.
- Over open wounds
- On areas of metal implants
Icing
Icing: is a very effective way of reducing inflammation and one of the most important aspects in the R.I.C.E.R principal (Rest, Ice, Compress, Elevate, Refer to a medical specialist). It is most effective in the first 48-72 hours after an injury with the effects diminishing significantly after then.
In injuries like heel pain and plantar fasciitis icing should be performed after completing exercise, stretching, and strengthening, and this treatment can be applied via ice massage, ice bath, or ice pack.
Ice can be useful for:
- Reduction of pain
- Prevention/reduction of local oedema after acute injury, when combined with compression.
- Prevention/reduction of haemorrhage when combined with compression.
- Reduction or control of inflammation (dec. in metabolism)
For acute injuries, ice for the first 24 to 48 hours after the injury. For chronic injuries such as plantar fasciitis or shin splints, ice after activity when you've re-aggravated the injury and are feeling pain. Never ice an area before activity.
We generally recommend icing an area for approximately 10-15 minutes and never longer than 20 minutes every four hours. Ice packs, or even a bag of peas should always be placed in a towel or cloth so the cold pack or ice is not in direct contact with the skin.
In injuries like heel pain and plantar fasciitis icing should be performed after completing exercise, stretching, and strengthening, and this treatment can be applied via ice massage, ice bath, or ice pack.
Ice can be useful for:
- Reduction of pain
- Prevention/reduction of local oedema after acute injury, when combined with compression.
- Prevention/reduction of haemorrhage when combined with compression.
- Reduction or control of inflammation (dec. in metabolism)
For acute injuries, ice for the first 24 to 48 hours after the injury. For chronic injuries such as plantar fasciitis or shin splints, ice after activity when you've re-aggravated the injury and are feeling pain. Never ice an area before activity.
We generally recommend icing an area for approximately 10-15 minutes and never longer than 20 minutes every four hours. Ice packs, or even a bag of peas should always be placed in a towel or cloth so the cold pack or ice is not in direct contact with the skin.
What is the RICER principal?
R.I.C.E.R Its stands for the essential elements required straight after an injury for better results and a quick recovery.
R is for Rest: Resting means avoiding as much movement or weight bearing in the injured area as possible to reduce further damage.
I is for Ice: for 20 minutes every 2-4 hours in the first 24 hours and every 4 hours after. Ice cools the tissue and reduces pain, swelling and bleeding.
C is for Compression: cover the injured area with moderately tight (not too tight) bandage including the areas above and below the injury. Compression reduces bleeding and swelling.
E is for Elevation: Keep the injured body part elevated above the heart while icing to further reduce swelling.
R is for Referral: Refer the injured person to a qualified professional such as a doctor, podiatrist or physiotherapist for precise diagnosis, ongoing care and treatment.
Note: Massaging and applying warmth to an acute injury shortly after it occurs may cause more harm and should be avoided until advised by a professional that it is okay to do so.
R is for Rest: Resting means avoiding as much movement or weight bearing in the injured area as possible to reduce further damage.
I is for Ice: for 20 minutes every 2-4 hours in the first 24 hours and every 4 hours after. Ice cools the tissue and reduces pain, swelling and bleeding.
C is for Compression: cover the injured area with moderately tight (not too tight) bandage including the areas above and below the injury. Compression reduces bleeding and swelling.
E is for Elevation: Keep the injured body part elevated above the heart while icing to further reduce swelling.
R is for Referral: Refer the injured person to a qualified professional such as a doctor, podiatrist or physiotherapist for precise diagnosis, ongoing care and treatment.
Note: Massaging and applying warmth to an acute injury shortly after it occurs may cause more harm and should be avoided until advised by a professional that it is okay to do so.
