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Preventing pain at work

Injury prevention

"Hot" or "Cold" ?

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Hot or Cold...

The decision depends on the "freshness" of the injury.
If the injury is recent, day 1 to day 3, then the P.R.I.C.E principle applies. Applying ice in this period is recommended to limit swelling and further tissue damage. Applying heat in this period is detrimental to the healing process and will worsen the pain and swelling.

Later, you may begin to apply heat to stimulate circulation and healing. You may alternate heat and ice to reduce swelling especially for peripheral joints (wrist, finger, ankle and toes). This technique is called contrast bath. In larger joints (neck and back, shoulder, elbow, hip and knee) you may simply alternate between a cold pack and a heating pad.

Heat is applied in particularly in chronic cases where pain is mainly due to joint or muscle tightness/stiffness. Heat is typically used during rehabilitation prior to exercise to decrease muscle stiffness, increase flexibility and range of motion, and thin joint fluid to minimize friction in the joint.

Ice is also applied immediately after an exercise bout if the injured area shows sign of pain or swelling. Application of ice in this case minimizes and limits the inflammation process due to micro-damages that might be produced by the exercise. Ice can also be useful in reducing chronic pain. In cases of chronic pain, try using heat or ice and decide which one works best for you.

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  • Acute musculoskeletal injury (immediately after the injury)
  • Chronic Pain relief for musculoskeletal injury

Physiological effects

  • Reduces pain by decreasing nerve conduction velocity
  • Decreases edema and swelling by limiting fluid infiltration into the area.
  • Decreases arterial, soft tissue and bone blood flow thus limiting hemorrhage
  • Decreases cell metabolism decreasing secondary hypoxic injury


  • Apply cold, static or with massage
  • Ice pack
  • Bag of frozen peas
  • Ice in dixie cups
  • Immersed in 55 F cool water
  • Alternative Techniques: Ice massage
  • Water frozen in paper cup
  • Rub ice over heel in circular motion for 5-10 minutes

Frequency: Every 2-4 hours

Duration: 15 to 20 minutes per application

Length of treatment

  • Acute Injury: 72 hours
  • Chronic Injury: as needed


  • Risk of Frostbite
  • Remove ice if skin becomes numb
  • Observe skin frequently for Frostbite
  • Use caution with fingers and toes
  • Risk of superficial nerve injury
  • Avoid applying ice longer than 20 minutes

Patients at risk for limb vasospasm or ischemia



Chronic Pain relief for musculoskeletal injury

Physiological effects

  • Acts as a painkiller by overstimulating the nerves in the skin to interfere with the nervous system's ability to recognize pain.
  • Increases blood flow to the affected area, providing nutrients and removing metabolic waste products, thus encouraging the healing process.
  • Relax muscles and soft tissues
  • Improve flexibility
  • Hasten recovery

Acute musculoskeletal injury under 72 hours

Cardiac condition

Apply local heat
Warm bath or shower (100 to 105 degrees)
Heating pad
Warm compresses

Duration: 15 to 20 minutes, 2-3 times a day

Adverse effects
Local burn injury
Orthostatic symptoms (warm bath, shower)
Precipitation of coronary ischemia (warm bath, shower) ___________________________________________________________________


Therapeutic heat and cold to distal extremity

  • Indication
  • Ligament Sprain or Joint capsule sprain
  • After initial ice only for first 72 hours
  • Stasis edema
  • Peripheral Vascular Disease
  • Improve circulation in contralateral extremity
  • Occurs by consensual vasodilatation
  • Exercise is more effective in PVD
  • Osteoarthritis or Rheumatoid Arthritis
  • Improves range of motion

Adverse Effects

  • Vigorous hyperemia
  • Discomfort during cold cycle
  • Issue of compliance


  • Warm Water Bath: 38-44 C (100-111 F)
  • Cold Water Bath: 10-18 C (50-66 F)

Technique 1: Decrementing Warm Baths (20 minutes)

Warm water bath for 5 minutes
Cold water bath for 1 minute
Warm Water bath for 4 minutes
Cold water bath for 1 minute
Warm Water bath for 3 minutes
Cold water bath for 1 minute
Warm Water bath for 2 minutes
Cold water bath for 1 minute
Warm Water bath for 1 minute

Technique 2: Fixed Warm Baths (30 minutes)

Warm water bath for 10 minutes
Cycle warm and cold baths for 4 repetitions
Cold water bath for 1 minute
Warm Water bath for 4 minutes