Ice is used immediately after injury with compression, elevation and support. Ice is used to control swelling, decrease bruising, decrease bleeding and decrease muscle spasm. It should be applied where there is normal sensation for 10min every 2hr while the person is awake for the first 24-72 hrs after the injury. Never apply directly to the skin but in a towel or pack. Movement can be done within the pain free range of movement while the ice is on and the limb elevated.
Heat is used for 10-20min to an area with muscle spasm or stiffness symptoms 48-72hr after injury or for long standing problems. The person should be awake and the area should have normal sensation.
The person can exercise or stretch with the heat on to assist the movement after the heat. Heat can be done by hot pack (moist and most penetrating), heating pad, hot tubs, sauna etc.
Physiotherapist start and end treatment with ice and heat so that patients recovery is enhanced with exercises, mobilizations, manipulation or other modalities

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