Patients need to use ice more often! It's one of my most frequent recommendations, but I find that patients tend to blow it off, waiting for the "real stuff" that costs more. In my experience, for musculoskeletal injuries, frequent use of ice is often the most significant interventions for improving function and outcome.
When I was in medical school, I remember one of the doctors I was following recommending "moist heat" to patients with an injury, and I still hear patients come in having had that as a recommendation. One would think, based on this recommendation, that there is a large literature supporting the use of moist heat. There is not.
For example, here is an article discussing the benefits of ice for the calf (http://www.ncbi.nlm.nih.gov/pubmed/12492271), and a subsequent article showing the lack of efficacy in using moist heat (http://www.ncbi.nlm.nih.gov/pubmed/19827506).
So why is moist heat recommended so often? The same reason that baseball managers used to focus on batting average instead of on-base percentage- it just became part of the orthodoxy, and no one thought to question it. Moist heat often feels good at time zero, so following it out over time to see if it makes a difference is not intuitive.
Before I completely poo poo moist heat, I would note there is some evidence of using moist heat immediately before activity (see, for example, http://www.ncbi.nlm.nih.gov/pubmed/11805451), so there is a rule for using moist heat before physical therapy. I would argue, however, that in most cases that a warm up of full range of motion exercise (e.g., long slow lunges or deep squats) is a preferable warm up.
The more common question I get from patients, though, is "I'm in pain, what medication should I take?" In another blog post, we'll talk about how pharmacologic management of musculoskeletal pain is almost always the wrong choice, but I usually recommend that the "medication" of choice is ice. When asked "should I use ice or heat?" the answer is essentially always ice.
How should you use ice? My normal recommendation is to make an "ice pillow" as per the directions below:
1. Take a high quality gallon size zip lock bag
2. Fill it about 1/3 of the way with ice cubes (crushed ice is even better, but I wouldn't sweat it if you don't have crushed ice)
3. Press out the remaining air, and tightly seal the bag
4. Wrap the redundant plastic around the remainder of the bag
5. If you have a skin condition or something that alters your sensation (e.g., diabetic peripheral neuropathy), then you should wrap the ice with a towel. For the vast majority of patients, though, it is safe and preferred to apply the ice directly to the injury.
6. If you can, apply some form of wrap to hold the ice compressed against the site of injury. For example, you can use an ACE wrap, or if it's in hard to compress area like the shoulder, putting it underneath tight fitting clothing (like a compression short or Under Armour shirt) can help hold in place.
7. Use for at least 20 minutes. In practice, I recommend doing something that occupies your thoughts for 20-30 minutes (e.g., paying bills online, watching TV). No major harm in doing it for a few extra minutes- most people tend to under ice anyway.
If you want to take your icing to another level, a cold compression device like the Moji is even better.
http://www.gomoji.com/?kw=moji&gclid=CILS0K7sorgCFUbhQgodCW8ARQ
If I have time, I may do a full review on the Moji at a later date. In short, it's a well designed device to help apply ice and compression at the same time. I particularly love the Moji knee, and use it myself.
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