Many people with carpal tunnel syndrome, wrist tendonitis or repetitive strain injury suffer with hand pain. They often say, "I've tried using ice or heat to relieve my hand pain" but also say that one (or the other) works better. The reason is that people frequently apply the wrong therapy to their condition. Like medicines, ice or heat are only for certain conditions, and applying an inappropriate therapy probably will achieve nothing.
It’s important to recognize that ice and heat are not cures, but simply aids in allowing the body to heal itself. To understand when you should use ice versus heat, you must first understand the difference between acute versus chronic injury.
Acute injury is when your tissues are traumatized suddenly by an external force. Examples are when you fall and sprain your hand or lift a heavy object. Acute injury triggers the body to react in order to protect the damaged tissues and also to speed their healing. And the main healing mechanism the body uses is acute inflammation.
In contrast, chronic injury usually develops slowly and subtly. Such injury usually occurs with constant irritation, pressure or movement. The most common chronic hand injuries occur with overusing or repetitively straining the hand. Tendonitis and sometimes carpal tunnel syndrome are classified as a chronic injury. The body reacts to speed healing using inflammation, but in this case it’s called chronic inflammation.
Acute and chronic inflammation are fundamentally different in what they do inside the damaged tissues. And that’s the basis for the difference in applying ice or heat to help your body heal. Depending on the injury, ice or heat can enhance the natural healing processes.
The Difference between Acute and Chronic Inflammation
The differences between acute and chronic inflammation are distinguished by the time course and the cellular healing processes that occur. Acute inflammation occurs from minutes to days after the injury. There is an increase in blood flow to aid in the protection and repair process. The application of cold keeps the tissues from “over-protection” which leads to extreme tenderness, pain and swelling.
In contact, chronic inflammation can last from days to weeks or even months. Certain blood cells stimulate tissue growth which allows them heal. Unlike using cold, applying heat during this phase enhances the repair process, but for reasons not well understood.
Ice for Acute Injuries
With acute injuries you should apply ice to the affected area as quickly as possible. This reduces blood flow in the traumatized tissues which consequently reduces the pain from inflammation.
To use ice, buy a soft ice pack (to conform your anatomy). Alternatively, a bag of frozen peas or crushed ice in a plastic bag works well. Use a protective layer of wet paper towel or cloth to protect your skin. Never ice for more than 20 minutes at a time. You should allow your skin temperature to normalize before re-icing (about an hour). You shouldn’t ice more than 5 times per day, and no more than 3 days in a row. The idea is to speed healing, and if the tissues do not heal you should seek medical help.
Heat for Chronic Injuries
With chronic injuries you should apply heat to the affected area. The heat is used as a means to boost the body’s long term healing process by bringing healing nutrients to the tissues and removing damaged components. With some chronic injuries, like carpal tunnel syndrome or wrist tendonitis, heat alone usually will not be enough to bring on full recovery. It these instances additional tretment is needed, such as daily deep tissue massage.
To use heat, apply moist heat (hot moist towel or heating pad/hot pack over a moist towel). Never apply heat to an acute injury or over skin inflammation. Never use heat for more than 20 minutes at a time since it will become an irritation and then get painful. As with icing, you should allow your skin temperature to normalize before re-heating (about an hour). Heat should not be over-used, and you shouldn’t heat more than 6-8 times per day. However, you can use heat on a much more long-term basis than ice.
But remember, the idea is to speed healing with heat, not to use it as a pain reliever (which won't work).
For carpal tunnel syndrome or wrist tendonitis you need to use additional therapy, like daily wrist and forearm myofascial release massage.
General Do’s and Don’ts
1. Do ice an acute injury (like a sprain) and heat a chronic injury (with additional therapy for carpal tunnel syndrome or tendonitis)
2. Don’t use ice and then heat (or vice versa). While some people advocate this, it makes no sense, and may even cause more pain. An injury is either acute or chronic, and should be treated accordingly. (Simply put, you don’t want to reduce blood flow on a chronic injury, and you don’t want to increase inflammation on an acute injury.)
3. Don’t ice before you expect to overwork or strain your hand or wrist. Restricting blood flow (by icing) to an area you think will be over-worked doesn’t make sense. Some people advocate heating the joint that’s expected to over-work, but the tissue will naturally warm up very quickly on its own, so pre-warming is pointless.
4. Don’t over-do ice or heat. They simply are aids in helping the body heal itself. If healing does not occur, then seek alternative remedies.
5. For carpal tunnel syndrome, don't forsake daily deep tissue myofascial release massage on your wrist and forearm: it's the only PROVEN method to relieve symptoms permanently.
Zimmerman, GR. Carpal Tunnel Syndrome. J Athl Train. 1994 March; 29(1): 22-24, 26-28, 30.
McDonald, JL. Fire and Ice: The great debate on the relative value of heat and ice in musculoskeletal therapy – a narrative review. Aust J Acupunct Chin Med 2007;2(2):3–8.
Collins, NC. Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emerg. Med. J. February 1, 2008 25:65-68
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