Cold or Hot? What should I use after a soft tissue injury?

This past week in the clinics, I was surprised to see patients in succession who attained sports injuries while playing. From an ankle sprain to muscle strains. What strike me the most, is that their first aid during the acute stage or within 24 to 48 hours after the injury is the application of heat on that area. The result is a more swollen and painful injured limb.

The rule of thumb for first aid in sports injuries or injuries sustained from a hard bump is to apply the RICE principle. RICE is the acronym for (R)est, (I)ce, (C)ompression, (E)levation on the affected area. Our body automatically reacts to the trauma it sustained (i.e. ankle landed unevenly on the floor causing an inversion injury) by making the area more swollen, reddish and warm or hot to touch. In worse cases, you see hematoma formation or blood clotting.

Now why (I)ce? Its effect upon application is that cold causes the blood vessels to constrict (become smaller). This then limits the amount of fluid to go out to the area and cause further swelling or hematoma formation.
If warm compress is applied instead the blood flow on that area increases and will further provide increased fluids that will aggravate the situation. Cold should be applied for 15 to 20 minutes every hour for at least 3 to 4 times or until it is seen by a physician when the patient is rushed to one.
As for the other components, (R)est or immobilization is needed in order not to further aggravate whatever is already injured. (C)ompression or bandaging snugly and (E)levating the area is done in order to prevent further swelling or direct the fluid back to the heart. If the patient feels increase in pain or further bluish discoloration of the distal part, the bandaging may be too tight. Remove and reapply it.

When does one shift to warm compress?
Definitely before doing so, consult your physical medicine and rehabilitation specialist as soon as you can on acquiring the injury. This is to further assess if the injury needs further evaluation (i.e. an xray, CTscan or MRI) and to provide medications that will help in the recovery. Physical Therapy may be recommended in order to prevent further complications of nearby or adjacent soft tissue.
The general guideline as to when to shift can be based on time or on signs or symptoms of the injured part. If time is used, it is usually 48 to 72 hours after the injury. If based on sign or symptoms, the element to consider is the characteristics of the swollen part. If it is still warm to touch or reddish, then cold should still be used.

Conclusion:
So if you have an injured limb, joint or muscle from playing or an accident RICE is your ally. HOT is NOT.