Sports injury is a type of injury that occurs while playing sports or during exercise. Inflammation occurs in response to an injury. The swelling of tissues and blood vessels allows immune cells (help fight infection) to reach the injured area. Although this process is crucial for healing, uncontrolled inflammation can cause intense pain and disability.
Early intervention is crucial in sports injuries as it can prevent long-term damage and accelerate healing. Prompt diagnosis and treatment help athletes manage pain; control inflammation; prevent scar tissue formation, which can hamper motion and flexibility; maintain performance levels and allow an early return to their sport. Both ice and heat therapies (discussed below) are effective, but the injury type determines whether cold or heat therapy should be applied. Ice therapy is used for acute injuries (explained below) to reduce swelling and inflammation, and heat therapy is used for chronic injuries (explained below) to relax the tissue and increase blood flow.
Acute injuries occur due to sudden trauma to the tissue, such as when you fall or twist a joint, with the symptoms appearing immediately. Acute injuries are classified based on the injury site (bone, cartilage, muscle, ligament, tendon, joint, bursa, skin or nerve) and the injury type (sprain, strain, dislocation or fracture). Acute injuries occur due to direct or indirect contact when the body part experiences a force that is greater than it can tolerate.
Direct Contact: This is caused by an external force, such as bumping into another person (e.g. during a football tackle) or being hit by an object (hockey stick).
Indirect contact: This can occur when the actual injury site is away from the impact site (e.g. a dislocated shoulder occurs when you fall on an outstretched hand) or the injury is due to your actions and does not involve an object or person, such as overstretching, fatigue, poor technique or lack of fitness (e.g. ligament sprain or muscle strain).
Chronic injuries develop over time due to excessive and repetitive use of a part of the body, with the symptoms gradually appearing. You may not experience pain at the beginning of the injury and may apply continuous pressure on the injury site, without giving enough time for the injury to heal.
The causes of chronic injuries are not as obvious as those of acute injuries. While exercising, the tissues undergo increased physiological stress. Once we stop exercising, tissues adapt themselves to become stronger to handle this stress in the future. Overuse injury develops when the tissue’s adaptive capability is exceeded.
Athletes at risk of overuse injury include those in elite sports and exposed to increased training load, insufficient recovery and tight competition schedules. (For example, symptoms of jumper’s knee were observed in 29%–44% of elite volleyball players who frequently performed 500 jumps weekly.) Overuse injuries are also observed among young and recreational athletes and sedentary individuals with brief bursts in activity levels. Common overuse injuries include stress fractures, osteoarthritis, tennis elbow and tendinopathy.
According to sports medicine specialists, the healing process is divided into three phases. The first phase is the inflammatory phase, which lasts approximately 2 days and protects the injured area from further damage. When an injury occurs, blood vessels are damaged, causing fluid accumulation and subsequent swelling. Thus, cold therapy (explained below) is applied to reduce fluid flow, which reduces circulation to the injured area and consequently reduces swelling. Heat therapy is contraindicated in this scenario as increased blood flow increases the swelling and prolongs healing.
The second phase is the proliferation phase involving the laying down of new tissue and the formation of scar tissue. Heat therapy can be applied in this phase to enable the healing process.
Heat therapy can be applied in the last phase, the remodelling phase, when the new tissue laid down in the second phase matures.
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The injury type and its severity decide the treatment plan. Medical history, physical examination, symptoms and imaging modalities, such as X-ray, computed tomography or magnetic resonance imaging are utilised to diagnose the injury type.
Following diagnosis, treatment may range from the traditional RICE method (rest [limit activity], ice [ice pack applied for 20 minutes at a time and at least 4–8 times a day], compression [an elastic bandage keeps pressure on the injured area to reduce swelling] and elevation [keep the injured area elevated above the level of the heart to reduce swelling]) or may involve advanced interventions, such as bracing, physical therapy or surgery.
The goal of the treatment is to reduce pain and inflammation, restore mobility and prevent further injury. This article focuses on the decision-making process for ice or heat therapy.
Ice therapy is applied using a crushed ice bag, cold compress or cold pack wrapped in cloth for the first 48–72 hours of an acute injury. Application of ice reduces surface temperature resulting in decreased cellular metabolism (cellular metabolism increases following injury, delaying the healing process), vasoconstriction (narrowing of blood vessels), reduced muscle soreness, reduced swelling (fluid accumulation in the neighbouring tissues is decreased) and reduced pain by preventing the pain sensation from reaching the brain.
To safely administer cold therapy, always wrap ice in a towel that acts as a barrier between the injured area and the ice to prevent skin damage and irritation. Never keep the ice pack in one place for more than 3-5 minutes to avoid frostbite. If you experience a feeling of numbness or the skin starts appearing red, remove the ice pack.
Ice therapy should not be performed for more than 15–20 minutes at a stretch as it may increase muscle contraction. However, the duration of treatment varies with the injury site, weather and temperature. For example, the duration of ice application is longer when the injury site is the quadriceps compared with the hand due to its thickness. Skin temperature is higher after exercise; therefore, the skin temperature takes longer to cool down when an injury occurs in hot weather than in cold weather.
Ice therapy should be avoided in conditions, such as reduced heart rate (bradycardia), lack of sensory perception (peripheral neuropathy), delayed wound healing (diabetes) and Raynaud’s phenomenon (reduced blood flow due to spasms in the small blood vessels of the extremities). Precautions should be taken when administering this therapy to the elderly and persons with circulatory problems, diabetes and cold allergies.
Heat therapy is recommended for chronic or overuse injuries and is typically performed before an exercise or an activity is performed. It causes vasodilation (an increase in blood flow) that promotes the influx of nutrients, oxygen, WBCs, proteins and antibodies, aiding the healing process. The application of heat therapy reduces muscle tightness, reduces joint stiffness and relieves pain.
Heat therapy is of two types: superficial and deep. Superficial therapies (dry and moist hot packs) transfer heat directly from the heat source to the injury site. Dry hot packs should be used cautiously as overheating can cause superficial burns on the skin. Hot packs are used for 15–20 minutes at a time.
Moist heat, such as a hot whirlpool tub or paraffin bath improves the range of motion of the injured area. A hot shower can also efficiently provide pain relief. Caution must be exercised to maintain the water temperature at levels that cause no sweating or discomfort.
Deep tissues are heated with ultrasound, which can penetrate 1.5 inches into the skin. This method promotes the healing of tissues unreachable by superficial heating methods. This method is expensive but can treat sprains and rotator cuff, hamstring or quadriceps strains.
Heat therapy should be avoided in acute injuries, body parts lacking sensation, poor circulation, eyes and genitalia, during pregnancy and on red, swollen or broken skin.
Contrast therapy is recommended by sports medicine specialists for injuries where heat or cold therapy has not individually provided relief and the injury is more than a week old. It is also suitable when both acute and chronic injuries are present, such as muscle strain with incessant soreness.
A pumping action is produced when cold and heat therapies are used in an alternating pattern where cold therapy restricts blood flow to reduce inflammation followed by heat therapy that promotes blood flow and aids in muscle recovery. Contrast therapy can aid in joint flexibility, functional mobility and pain relief. Injuries that benefit from this therapy are joint or soft tissue injuries, such as dislocated elbow or Achilles tendinitis (swelling, inflammation and pain in the Achilles tendon, the tissues connecting the calf muscles to the heel bone).
Two whirlpool baths, one cold and the other hot are used. Once the baths are at the appropriate temperature, the injured area is immersed in the hot bath for 3–4 minutes followed by immersion in the cold bath for 1 minute. In the hot bath, gentle-motion exercises are recommended to increase joint mobility; in the cold bath, the joints are relaxed. This alternating treatment is continued for 20–30 minutes. Contrast therapy is not recommended in persons with ruptured blood vessels, peripheral neuropathy (damage to the peripheral nervous system causing pain and numbness in the hands and feet) and peripheral vascular disease (narrow or blocked blood vessels reducing blood flow to the limbs).
Once the injury has healed, physiotherapists initiate a rehabilitation plan to rebuild strength and range of motion and prepare the athlete’s return to the activity that caused the injury. Most rehabilitation exercises can be done in the comfort of your home, helping you regain your previous activity levels and reducing chances of re-injury.
A sports medicine specialist must be consulted if swelling or pain does not subside. Serious injuries may require treatment that includes immobilisation using slings (for arms and shoulders); splints, casts or braces (support injured soft tissue and bone) or surgery (connective tissue repair or bone re-alignment).
For personalized and comprehensive treatment of sports injuries, turn to Kauvery Hospital. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our skilled team of healthcare professionals utilises advanced techniques and therapies to bring you back to your peak performance. Trust us to aid your recovery and help you safely return to your sport!
Most athletes use temperature therapy for injury management. Heat therapy is useful for chronic injuries as it increases blood flow and relaxes the muscles. Ice therapy is useful for acute injuries as it reduces blood flow and controls swelling and inflammation. Contrast therapy is useful when the healing process is ineffective using heat or ice therapy alone. Using vasodilatory and vasoconstrictive properties of heat and ice therapy, respectively, can efficiently manage pain and promote recovery. In conclusion, choosing between heat and ice therapy is crucial while dealing with sports injuries as the right therapy at the right time optimises the healing process.
Should I use ice or heat for a sports injury? Use ice for swelling and fresh injuries. Use heat for muscle stiffness and chronic pain.
How long should I apply ice or heat to an injury? Apply ice for 15–20 minutes at a time. Use heat for 15–30 minutes.
Can I use ice and heat together for an injury? Yes, alternating ice and heat can help with recovery but start with ice first.
When should I avoid using ice on an injury? Avoid ice before physical activity or if you have poor circulation.
When should I not use heat for pain relief? Don’t use heat on fresh injuries, swelling, or open wounds.
Is ice or heat better for muscle pain? Ice is better for sudden muscle pain, while heat is good for long-term soreness.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
