Should I use hot or cold packs on a sprained foot?

Better Nutrition, Dec, 2004 by Jose Valdez

--Jose Valdez, Los Angeles.

When you sprain a joint, a series of biochemical reactions--known as an inflammatory cascade--happens as a result of the tissue damage. This cascade is mediated by several substances such as prostaglandins; cytokines such as interleukin-1 (IL-I), IL-6, IL-8, and IL-12; the Cox-2 enzyme; glutamate and substance P. The injury, also releases nitric oxide, which causes pain and slows the healing process.

These chemicals cause changes in the sprained joint. The blood vessels widen in an attempt to bring more blood to the injured joint.

Applying heat causes blood vessels to open wide. This is useful for chronic conditions where circulation is permanently impeded to the joint. This is why heat is popular with older people--their pain is chronic and they need to stimulate circulation--but it is of little value in treating all acute injury.

Applying cold to a recent sprain causes the blood vessels to constrict. It also deadens pain receptors at the injury site. Athletes, for example, apply ice to their bodies immediately after sporting events to reduce inflammation and lessen pain.

But if you also want to heal the injury quickly, you can use what is called contrast therapy a combination of hot and cold packs. Contrast therapy maximizes the flow of blood and causes pain modulators to be flushed from the site of injury and to be broken down elsewhere in the body. The increased blood flow also speeds healing of the joint.

After you sprain a joint, apply cold packs for 20 minutes to reduce swelling. An hour after that, apply a hot pack for 2 minutes followed by a cold pack for 30 seconds to 1 minute, and then another hot pack for 2 minutes and another cold pack for 30 seconds to 1 minute. Repeat this cycle one more time, beginning with a 2-minute hot pack, and you have completed one session of contrast therapy. The length of time suggested for each application comes from my clinical experience.

In between treatments, apply arnica gel to the injury site. (Do not use arnica on broken skin.) Other supplements that help reduce inflammation and pain include essential fatty acids, turmeric, boswellia, ginseng, 5-HTP and amino acids such as isolcucine, leucine, valine and taurine. Follow the manufacturer's suggestions for dosages. The essential oils rosemary ginger and nutmeg, when applied topically, are good for sprains. Mix 10-20 drops of an essential oil in a carrier oil such as olive oil or grapeseed oil, and apply it to the injury site.

Frank Ervolino, ND, lives in Palm City, Florida. He's on the staff of Jupiter Medical Center Hospital as an acupuncturist. He received his doctorate of naturopathic medicine and a master's of science degree in acupuncture from Bastyr University in Seattle, Washington. In 2003, he was appointed by the governor to the Florida State Board of Acupuncture.

Dr. Ervolino is happy to answer your health questions, Email him at askdre@adelphia.net.