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How to Apply Ice or Heat to Injured Ankle

by Jaydee Vykoukal, PT, DPT January 16, 2020 0 Comments

Wearing Cold Brace

Injuring your ankle can be a major setback, whether it’s a sprained ankle, twist or fracture. It leaves you feeling stiff, sore, and swollen. Ultimately, affecting your quality of life and ability to get back to the activities you love. Ice and heat are both simple, effective, economical treatments you can use to gain an upper hand in your recovery process. Not sure when to use ice or heat for an injured ankle? Keep reading to learn more.

When and How to Use Ice Therapy

Ice is a quick and easy initial step to managing pain and swelling. If you are unsure of the severity of your injury, you may want to see a doctor first. Otherwise, ice can be an immediate first step to preventing unnecessary swelling. It is also an ideal option for managing pain and swelling that can get slightly worse when you begin (and progress) an exercise program.

How to Properly Apply Ice

There are actually three steps of “cold” you need to go through to achieve therapeutic pain and swelling relief.  These are (1) aching, (2) burning, and (3) numbness. You must endure the first two steps to get to the numbing benefits of ice.  Here are some general rules for ice application:

  • To achieve therapeutic numbness, only use a thin layer between your skin and the ice.  A t-shirt or a pillowcase works well, but NOT a towel.  
  • It usually takes about 10-15 minutes to achieve “numb” status (less with ice massage).
  • Once the area is numb, you can stop icing.  
  • If you keep the ice on more than 15-20 minutes, your body will actually reflexively dilate the surrounding vessels, completely defeating the purpose of using ice. More is not better.

Benefits of Cold Therapy

When you apply ice to a specific area, it constricts the blood vessels in the area. This temporarily pushes fluid out of the area and keeps new fluid from returning to better control swelling. The numbness associated with ice also relieves pain. Excessive pain and swelling can lead to a poor cycle of ankle dysfunction. Thus, ice is a great way to keep this entire issue under control and you feel more comfortable.

Best Ways to Apply Cold Therapy

  • Cold Pack or Ankle Ice Wrap

    Simply remove it from the freezer and place it where it is needed. A wrap will provide compression for additional pain and swelling management. 

  • Topical Gel

    It provides a soothing and cooling sensation on the skin specifically for temporary pain management.

  • Ice Massage

    Most often, water is frozen in a paper cup and then rubbed directly on the injured area for 5-10 minutes.

  • Ice Therapy Machine

    This machine circulates ice water through a sleeve specifically designed for the ankle joint. Typically, compression is added to provide additional swelling management.

  • Ice Bath

    Placing the foot and ankle in a bucket or tub of freezing cold water can address large areas all at once.

When and How to Use Heat Therapy

Heat is generally a more agreeable treatment option for any injury when it is a possibility. Heat can be applied throughout the recovery process. The only time it is not recommended, is when excessive swelling is present or within the first few hours to days of an injury (depending on severity). It can be used before and after exercise and treatment to help with pain, stiffness, and stress management.

Benefits of Heat Therapy

For most people, heat feels great. It increases blood flow to help speed the healing process. Additionally, it decreases stiffness and promotes relaxation. It can also help promote better sleep, an important part of the healing process. Plus, relaxation can help maximize tolerance for other treatment recovery options such as ankle range of motion and massage.

Dry vs Moist Heat

If you’ve ever traveled or lived somewhere with high humidity, you are probably aware of the way it magnifies the heat. Moist heat has been shown to get a few extra millimeters into the skin when applied. This can boost the potential benefits of relaxation and circulation. Some electric heating pads come with a moisture sleeve you can add (with caution). If you are treated in a clinic, such as with a physical therapist or chiropractor, they usually have a special type of moist heat to apply to your ankle to maximize the benefits.

Best Ways to Apply Heat Therapy

  • Gel Packs

    These are typically heated in water or the microwave and placed where needed.

  • Electric Heating Pads

    Simply plugin and set it at the level of warmth you want.  Be sure to turn it off when you are done.

  • Hot Water Bottle

    Fill the bottle with water at the desired temperature and enjoy.

  • Bath

    Draw yourself a hot bath and relax the entire body. Or put warm water in a bucket just for your foot and ankle.

  • Sauna

    Promote circulation throughout the body with this relaxing form of dry heat.

Why Swelling Happens

Swelling is often demonized with a new injury due to the pain that occurs with it. However, swelling is actually a normal, even necessary, part of the healing process. It allows for the right cells to get into the injured area to start repairing. However, anyone that has experienced swelling knows that it can be very uncomfortable. Thus, ice can be used to better manage pain.

How to Reduce Swelling in a Sprained Ankle

Alternating Cold and Hot Therapy

Alternating between ice and heat is a great way to maximize the circulatory benefits of both treatment options. Alternating between constriction and dilation of the blood vessels in the ankle can be very therapeutic for optimizing healing. The general rule of thumb is to alternate a few times throughout the day. If you have a newer injury or a lot of residual swelling, try to end with ice. Otherwise, you may choose to end with the more relaxing heat. It’s all about preference.

Safe Application of Cold and Hot Therapy

Cold and heat both require close attention to skin quality throughout treatment time. There is a risk of frostbite or burns if sensation is compromised or you don’t frequently check your skin quality. Here are some contraindications to be aware of when using ice or heat.

  • Avoid using ice or heat if you have diabetes, vascular disease, or decreased feeling in the ankle.
  • Avoid using heat if you have MS to prevent relapses.
  • After either treatment option, don’t force any movements or exercise due to altered sensation.

Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.

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