I spend much of time reminding people when to use Ice and when to use Heat.  Dr. Lowe, put it together very nicely for us in an article he wrote.   I wanted to share some of that paper with you here. 

Heat or Ice? Determination Based on the Phase of Healing

The general advice of applying ice for the first 24 to 48 hours followed by heat is based upon the idea that the patient has progressed from the acute inflammatory phase to the repair or regeneration phase on a normal time scale.

Overuse of the injured area, premature application of heat, and other factors can prolong the normally short-lived inflammatory phase. Research also shows that the overuse of ice can slow the healing process, so how does one assess when it is appropriate to use ice and heat?

Pain during the acute inflammatory process is caused by multiple factors. Besides pain generated by the initial damage to the injured tissue, pressure from tissue swelling and stretching of sensitive structures has been found to be a significant contributor to the pain, as are the multitude of acute inflammatory chemicals released by local tissue destruction and the invading cellular response. Chemicals such as prostaglandins, leukotrenes, bradykinin, histamine, etc., and the change in pH all contribute to cause constant chemically stimulated depolarization of the pain fibers. The concentration of these chemicals, and their resultant sequelae of swelling and the constant barrage of the pain neurons, are slowly removed as the acute inflammatory phase shifts to the repair-regeneration phase. Hence, their influence on the constant perpetuation of "c-fiber" stimulation diminishes.

While the pain neurons continue to have a lowered threshold of firing, they no longer have constant chemical irritation. The quality of pain at this phase is one in which the patient can find a pain-free or relatively pain-free position (depending on severity of initial tissue damage) but has pain with movement, or only when weight-bearing (subject to mechanical stress). During this phase, patients may say that they don't feel pain, just "stiffness," unless they make a provocative movement (which can include weight-bearing).

As a general rule, which is very easy for patients to understand, inflammation is present if there is no pain-free position (chemically mediated pain), and if the condition is in the repair phase when the patient can get into a pain-free position, but still has pain with movement or other mechanical stress to the tissues. In conjunction with the use of ice or heat, here are two "rules of thumb":

• no pain-free position - use ice
• pain-free position, but pain with movement - may use heat

The complete article by Dr. Lowe was well done.   He presented important aspects necessary for consideration when deciding on the appropriate application of either heat or ice to an injury.   Visit the entire article at: Dynamic Chiropractic – September 18, 2000, Vol. 18, Issue 20 authored by Duane T. Lowe, DC, DABCI

I wanted to share a recent study about injury from whiplash trauma.   This article helped us to focus our treatment applications to improve mechano-reception, neuromuscular rehabilitation, and mechanical traction to improve treatment outcome.

Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study.  Author(s): Kasch, H; Qerama, E; Kongsted, A; Bach, FW; Bendix, T; Jensen, TS  Journal: Pain 2008 Sep 5; Vol. 140, Issue 1; Page(s) 65-73 [Medline ID - 18768261]

Local sensitization to noxious stimuli has been previously described in acute whiplash injury and has been suggested to be a risk factor for chronic sequelae following acute whiplash injury. In this study, we prospectively examined the development of tender points and mechano-sensitivity in 157 acute whiplash injured patients, who fulfilled criteria for WAD grade 2 (n=153) or grade 3 (n=4) seen about 5 days after injury (4.8+/-2.3) and who subsequently had or had not recovered 1 year after a cervical sprain. Tender point scores and stimulus-response function for mechanical pressure were determined in injured and non-injured body regions at specific time-points after injury. Thirty-six of 157 WAD grade 2 patients (22.9%) had not recovered, defined as reduced work capacity after 1 year. Non-recovered patients had higher total tender point scores after 12 (p < 0.05), 107 (p < 0.05) and 384 days (p < 0.05) relative to those who recovered. Tenderness was found in the neck region and in remote areas in non-recovered patients. The stimulus-response curves for recovered and non-recovered patients were similar after 12 days and 107 days after the injury, but non-recovered patients had steeper stimulus-response curves for the masseter (p < 0.02) and trapezius muscles (p < 0.04) after 384 days. This study shows early mechano-sensitization after an acute whiplash injury and the development of further sensitization in patients with long-term disability.