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When to switch from cold (vaso-constriction) to heat (vaso-dialation)?

rmillerrmiller
in General Training Discussions

In the immediate aftermath of an injury, it's pretty common knowledge at this point that cold is preferred to reduce swelling and inflammation that can cause collateral damage.  However, a degree of inflammation is necessary for healing, and it would be counterproductive to continue applying cold to an injury because it would hamper blood flow.

So, when is the right time, either in terms of hours after an injury, or any other metric, to switch from cold to heat?

The reason I'm asking is that during my run yesterday, thanks to crappy roads from snowbanks, I rolled my left ankle a little bit.  Didn't hurt at all at the time, but I knew right away that there was a good chance that I'd at least mildly sprain something.  Finished the run (another 1.5 - 2 miles), got home and did the legs up thing, and went about my day not feeling anything.  Then towards the end of the day, it started feeling a little sore.  This morning and today, it's a little more sore.  Probably 3 or 4 out of 10 - certainly noticeable during the plantar flexion phase of walking, but not gait affecting.  Just.. sore, at the point where the tendon (I think it'd be the peronial tendon) meets up with the muscle.

It's been about 24 hours, and I'm just curious whether I should be applying heat to it at this point, since it's not incredibly sore and presumably any damage that could be done via inflammation has already been done - or am I better off applying ice packs for another 24 hours or so?

Comments

  • russGrussG

    Hey Ryan - so sorry to hear that! I would certainly ice up to 48 hours afterward - maybe longer.  I like the "peas" ice products from CVS a lot (not that I EVER have injuries, except when I do).  For a rolled ankle, I'm not sure I would go to heat at all.  Heat to me is for relaxing muscles to release them and gently lengthen them after a pull.  A rolled ankle isn't about muscle damage - it's all tendons and ligaments down there.  MOST important is simply to NOT reinjure - a common side effect of a excessive and irrational exuberance! 

    Hope it feels better soon!

    r

  • [Deleted User][Deleted User]
    Just so you know I am a physical therapist. I would ice only for 72 hours at least. I would also advise you to use some compression such as an ace wrap or now adays the compression full socks work well for ankles. After that I would still ice and wrap after your running at least. I would do this for the first 2 weeks after injury before considering any heat.
  • rmillerrmiller
    ok, cool - thanks. This evening I did my normal Monday yoga, and I've had that be surprisingly beneficial for soft tissue injuries before (something with the combination of heat plus massive bloodflow seems to help - as I've never been able to have the same drastic results with one in the absence of the other). It's a little better now than it was earlier today, so we'll see how it is tomorrow. I'll pop a couple advil as well for the evening.

    It's really not bad at all - just a little sore above the ankle. I could certainly run on it - the ankle feels completely solid and stable - but I'm thinking that I'll bail on tomorrows brick easy run (I normally bail on the Tuesday runs anyway) just to give it more time w/no running stress.

  • russGrussG

    Hi Ryan - I'd recommend finding a track or treadmill (or other reliably smooth surface) as well - you may already be there.  Reinjury is a bigger risk than simple irritation if your ankle is runnable.  We all know what this looks like - you're near the end of your second to last interval and you hit a pothole and you're down and you've just lost weeks.  To avoid this undesirable scenario - prioritize finding a safe surface, such as a track or treadmill, and be extra mindful as you crank these out.

     

  • rmillerrmiller
    Posted By Russell Green on 08 Jan 2013 02:43 PM

    Hi Ryan - I'd recommend finding a track or treadmill (or other reliably smooth surface) as well - you may already be there.  Reinjury is a bigger risk than simple irritation if your ankle is runnable.  We all know what this looks like - you're near the end of your second to last interval and you hit a pothole and you're down and you've just lost weeks.  To avoid this undesirable scenario - prioritize finding a safe surface, such as a track or treadmill, and be extra mindful as you crank these out.

     

    I was thinking about it earlier today - reflecting on your previous post, and I determined it made sense.  When I initially read 'reinjure', I was thinking that the injury didn't come about from running mechanics, so initally I wasn't concerned about that - but then I realized that yeah - all I have to do is slightly misstep and only partially roll the ankle in the same way again, and I'm worse off.

    Fortunately tomorrows run is VO2max, so relatively easy to do on a short course, as opposed to a long weekend run.  With that in mind, I'm thinking I'll just stay in the local neighborhood and bust it out there where there is little traffic and good road conditions.

  • zharveymdzharveymd
    Current recommendations are the familiar RICE acronym.
    Rest
    Ice: ice for 15 to 20 min every one to two hours for 48 to 72 hours. After this time period use heat only.
    Compression: very light compression to help reduce swelling
    Elevate to keep swelling down

    Add to this use tylenol and/or a non steroidal anti-inflammatory (like Ibuprofen or aleve) for the first 5 or 7 days. Helps with pain and swelling.
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