Friday, 13 June 2014

heat or ice ?

Reflecting on the recent (30/05/2014) article and discussion 'Ice may no longer be the treatment of choice for injuries'  ( please see last blog) which suggests that ice - certainly excessive or prolonged icing - may actually slow down the healing process:
''Applying ice causes blood vessels around the injury to constrict and shut off the blood flow that brings in the inflammatory cells needed for healing.''

So the question becomes - should we use heat then?

Immediately after injury  (and several hours following) ice (an ice pack wrapped in a towel - not directly onto the skin) or at least cooling, can be applied, especially if there is any swelling.  The ice (or cooling) will reduce, or slow down, the inflammatory response - by local vasoconstriction in the tissues

After two or three days following an injury, it is unlikely that ice will have much benefit - and even if there were swelling, there would be other treatments available, including acupuncture and perhaps lymphatic drainage.

According to the recent article, it is even possible that ice (certainly excessive or prolonged) may even be harmful.

So when do we use heat?
Heat is most useful for sub-acute (several days) or chronic conditions.  In chronic conditions it may be helpful to promote blood flow, which will happen from the vasodilatation in the tissues resulting from heat.

However, remember that the blood also needs to get out again, and circulate, so even heat perhaps should not be applied for to long or excessively.  Perhaps a heat pack for 10 - 20 minutes, rather than falling asleep with a hot water bottle over the area!

In clinic I consider carefully if to use heat, and in what form.  Traditionally in Acupuncture, Moxibustion is used, and there are varying forms of Moxibustion, either heating over the area where the needles are (with a moxa roll) or perhaps using moxa on the needle (warm needle technique).  Another method (one I don't use here in clinic) is burning small amounts (cones) of moxa, perhaps on ginger, on the skin, and removing it before it becomes to hot!

There are also magnetic heat lamps which provide infra-red heat to the area. These have the advantage of being easy to use, and not creating any smoke or smell like burning moxa does.  However, the heating affect is over a fairly large area.  This is maybe OK for the upper or lower back or shoulder area. On the other hand moxa can be more specific, giving heat to a relatively small, specific area, without heating the surrounding tissues.

Interestingly even though Western physical therapy and Sport's medicine seem favor ice more than heat, there is one commonly used treatment in physical therapy which does have some heating affect, and this is ultrasound treatment.  Ultrasound treatment appears to speed up the healing process and increase the blood flow to the treated area.  Some of this is probably from it's heating affect, and it is likely that heat has similar effects.

For more on Osteopathy and Acupuncture you might want to look at: