For a sprained joint, should you apply heat or cold?

In daily life, various joint sprains are common, not only in various sports and accidents, but also in walking, going up and down stairs, picking up objects, etc. The most common joint sprain is the ankle sprain, commonly known as "sprained ankle", followed by hip, knee, wrist and elbow sprains.

Once a sprain occurs, if the situation is not particularly serious or if it is inconvenient to seek medical treatment, many people will choose to deal with it themselves. Compared with the method of "applying herbal wine for massage", which requires a certain amount of practical experience, the method of "a towel + a basin of water" is simpler and easier. However, if you think about it carefully, you will find that there seems to be both cold and hot compresses after a joint sprain, but which one is correct is unclear for a while.

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After a joint sprain, should we apply heat or cold? To understand this question, we must first know what changes have taken place in our body after a joint sprain.

Joints are important structures that connect two parts of the human skeleton. They are responsible for the transmission and buffering of human force and the fulcrum of bone movement. When a joint is sprained, the first thing to be injured is the soft tissue around the joint. Strictly speaking, a joint sprain mainly refers to ligament damage. Of course, some injuries may also be accompanied by tendon, joint capsule, cartilage damage, and even fractures. Once the human body is injured, the self-repair program is also activated. The human body's response to injury is mainly divided into the following stages:

01

Ice compress during the coagulation period is helpful for hemostasis and pain relief

Injury can cause different degrees of rupture of small blood vessels under the skin, leading to bleeding, which is why we often see bruises after sprains. The human body's response to bleeding is mainly in the following two ways: one is the contraction of small blood vessels to stop bleeding, and the other is to start platelet aggregation and coagulation pathways to form tiny blood clots to block the rupture of blood vessels. Therefore, in this period, we usually use ice compresses to promote blood vessel contraction and reduce bleeding. At the same time, ice compresses also have a certain analgesic effect.

On the contrary, if you apply hot compresses or use medicinal wine that promotes blood circulation and removes blood stasis during this period, the small blood vessels will expand, increasing bleeding and pain. Therefore, in the early stages of a sprain, ice compresses should be applied instead of hot compresses. It is usually recommended to apply ice compresses within 24-72 hours after the injury, for 15-30 minutes each time, 3-4 times a day. If a local pressure bandage is applied to the injured joint at the same time, it can further compress and stop bleeding and reduce local swelling in the later stage - the inflammatory stage. Therefore, it is a good choice to always have a roll of elastic bandage in your home first aid kit.

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02

Applying pressure bandage to reduce swelling during the inflammatory period

After the blood vessels contract in the early stage of injury, with the release of some cytokines, the blood vessels expand instead, and various inflammatory cells gradually migrate to the injured area. After the cells are damaged, toxins are released, and the permeability of blood vessels and cells increases, causing tissue swelling. In this stage, the injured area manifests as pain, fever, redness and swelling. At this time, applying appropriate pressure to the affected area and raising the injured limb can reduce local swelling.

03

Hot compress should be applied during the granulation period

The granulation period starts from the second to third day after the injury and generally lasts for several days. During this period, fibroblasts are generated and migrate to the wound to form granulation tissue, fill the injured cracks, repair the synthesis of collagen fibers in the tissue, and new capillaries begin to form. During this period, we can start hot compresses.

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04

Scar formation period

Months of tissue repair

This stage is a continuation of the previous stage and can last for several months. Various types of collagen fibers continue to be synthesized during this stage, and the composition is adjusted and rearranged to achieve the transformation of the scar. It is worth noting that the repaired tissue rarely recovers to its original strength and elasticity. The stress conditions at the scar often affect the composition and arrangement of collagen fibers. Excessive force or prolonged braking time may cause abnormal arrangement of collagen fibers, affecting repair, making it even more difficult for the ligament strength and elasticity to recover to their original level.

In the early stages of injury, proper immobilization (such as using elastic bandages or protective gear, or even plaster fixation) not only helps relieve pain and prevent further injury, but also helps repair tissues. After the acute phase, external immobilization measures can be removed, and appropriate activities can be performed to accelerate the regeneration of collagen fibers and the recovery of muscles and joints.

In summary, after a joint sprain, different treatment measures should be taken according to the changes in the body at different stages. If you understand the body's reaction after the above injury, you can better understand the POLICE principle for treating ankle sprains, namely protection (P-protect), appropriate weight bearing (OL-optimal loading), ice (I-ice), compression bandage (C-compression), and elevation of the affected limb (E-elevation). This principle is not only applicable to ankle sprains, but also to other joint sprains.

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Minor injuries and bumps are inevitable in life. Although they will not endanger life safety, the first-time treatment and subsequent care during the recuperation period directly affect the recovery of the affected area. Relying on vague impressions and acting rashly will not only be of no help to recovery, but may even go in the opposite direction and cause more serious injuries. Paying more attention to medical popularization and accumulating correct knowledge can better solve problems at critical moments.

Author | Li Juan, attending physician

Li Xilei, deputy director and chief physician of the Department of Orthopedics, Zhongshan Hospital, Fudan University

Review | Guo Changan, Chief Physician of Orthopedics, Zhongshan Hospital Affiliated to Fudan University

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