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by Jack R. Giangiulio, D.C., B.S. (December 2008)

The most common question I hear is, “Doc, should I ice or heat after an injury?”  The answer is simple, if your not sure, ICE.  If you have a traumatic injury ice should be used within the first 72 hours (3 days).  Ice not only reduces inflammation (by reducing the blood flow), it will also decrease pain.  In general, ice should be applied for no longer than 20 minutes and no less than 10 minutes.  If you use ice for less than 10 minutes, you will not obtain the beneficial effects.  If you use it for longer than 20 minutes, you will experience the Hunting Response.

To summarize a complicated process, the Hunting Response is your brain saying, “This ice is freezing me.  It’s going to stop my blood flow!  I better dilate (widen) my blood vessels to get more blood to the area.”  This response is a rebound dilation of the blood vessels that may cause an increase of inflammation to the injured area; therefore causing more pain.  Keep in mind to ice for only 10–20 minutes and at most 2-3 times per day with at least 20 minutes between icing sessions.

After 72 hours you may use moist heat.  Moist heat tends to relax and soften the injured area.  This allows for an increase in the range of motion.  It also increases blood flow to the injured area; this is a good thing after the first 72 hours.  A flush of blood brings the Good Guys (nutrients and oxygen) to the injury site, which aids in the healing process.  This same increase in blood flow removes the Bad Guys (toxins and dioxides).  Moist heat should be applied for 15–20 minutes and no more frequently than 2-3 times per day, with at least 20 minutes between heating sessions.

The above is the basics of utilizing ice and heat.  There are other ways of applying ice and heat, such as, ice massage, ice bath, and contrast therapy.  These methods are more complicated and if used incorrectly may lead to an undesired physiological response.  Let’s save these topics for future articles.  For now, just remember, if you use heat too soon you may aggravate your injury.  SO WHEN IN DOUBT, ICE!


- Dance Long and Healthy   

Jack R. Giangiulio, D.C., B.S. is internationally known for treating dance professionals and athletes in his Newport Beach, California office.  He is a sought after media consultant and lecturer as well as a prior Assistant Professor at the Southern California University of Health Sciences and held the title of Lecturer at the University of California, Irvine.  He is published in Dance Teacher Magazine, Dance Spirit Magazine, SportingKid Magazine, OC Parenting Magazine, Dynamic Chiropractic, DROC News and

For more about Dr. Giangiulio go to

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