How do you treat a sprained ankle with ice and heat. When should you use ice vs heat for sports injuries. What are the best practices for using icy hot treatments on sprains and strains. How long should you ice or heat an injury.

Understanding Sprains and Strains: Common Sports Injuries

Sprains and strains are two of the most frequent sports-related injuries that athletes and active individuals encounter. While they may seem similar, there are key differences between these two types of soft tissue injuries:

What is a Sprain?

A sprain occurs when ligaments – the tough, fibrous tissues that connect bones to other bones – are stretched or torn. Sprains commonly affect joints like ankles, knees, and wrists. Symptoms of a sprain typically include:

• Pain and tenderness around the affected joint
• Swelling
• Bruising
• Limited range of motion
• Instability in the joint

What is a Strain?

A strain, on the other hand, involves injury to muscles or tendons – the fibrous cords that attach muscles to bones. Strains often occur in the lower back, hamstrings, and shoulders. Common symptoms of a strain include:

• Pain and muscle spasms
• Swelling
• Limited flexibility
• Weakness in the affected muscle

Do sprains and strains require different treatment approaches? While both injuries benefit from the RICE method (Rest, Ice, Compression, Elevation), the specific application of ice and heat can vary depending on the type and stage of the injury.

The Science Behind Icing an Injury

Icing an injury is a time-tested method for managing acute pain and inflammation. But how exactly does ice therapy work?

How Ice Therapy Affects the Body

When you apply ice to an injured area, several physiological changes occur:

1. Vasoconstriction: Cold causes blood vessels to constrict, reducing blood flow to the area.
2. Reduced inflammation: Less blood flow means less swelling and inflammation.
3. Pain relief: Cold temperatures slow nerve impulses, dulling pain sensations.
4. Metabolic slowdown: Cooling an area decreases cellular metabolism, potentially limiting further tissue damage.

Is icing always beneficial for injuries? While ice therapy can be highly effective, it’s important to use it correctly and at the right time in the healing process.

The Benefits of Heat Therapy for Injuries

Heat therapy, while often considered the opposite of ice therapy, can be equally beneficial for certain types of injuries and at specific stages of healing. But how does heat therapy work?

Physiological Effects of Heat Application

When you apply heat to an injured area, the following changes occur in your body:

1. Vasodilation: Heat causes blood vessels to expand, increasing blood flow to the area.
2. Increased circulation: Enhanced blood flow brings more oxygen and nutrients to the injured tissues.
3. Muscle relaxation: Heat helps relax tense or tight muscles, reducing pain and improving flexibility.
4. Pain relief: Increased blood flow can help flush out pain-causing chemicals from the area.

Can heat therapy be used for all types of injuries? While heat can be beneficial, it’s crucial to understand when and how to use it properly to avoid exacerbating certain injuries.

Ice vs. Heat: When to Use Each for Optimal Recovery

Knowing whether to use ice or heat for an injury can significantly impact your recovery. The general rule of thumb is to use ice for acute injuries and heat for chronic conditions, but let’s delve deeper into specific scenarios:

When to Use Ice

Ice therapy is typically most effective in the following situations:

• Immediately after an acute injury (within the first 24-48 hours)
• For injuries accompanied by visible swelling
• To reduce pain and inflammation from sprains, strains, and bruises
• After exercise to prevent inflammation

When to Use Heat

Heat therapy is generally more beneficial in these scenarios:

• For chronic, nagging injuries (those lasting longer than 6 weeks)
• To loosen tight muscles before activity
• For arthritis pain
• To improve flexibility and range of motion

Can you alternate between ice and heat treatments? In some cases, alternating between cold and heat therapy (known as contrast therapy) can be beneficial, especially for subacute injuries (those between the acute and chronic stages).

Proper Techniques for Applying Ice and Heat

Applying ice or heat incorrectly can not only reduce the effectiveness of the treatment but potentially cause harm. Here are some best practices for both ice and heat application:

Ice Application Techniques

To safely and effectively apply ice to an injury:

1. Wrap ice or an ice pack in a thin towel to protect your skin from direct contact.
2. Apply the ice for 15-20 minutes at a time.
3. Allow the skin to return to normal temperature before reapplying (usually about 2 hours).
4. Never fall asleep with an ice pack on your skin.

Heat Application Techniques

For proper heat therapy:

1. Use a heating pad, hot water bottle, or warm compress.
2. Apply heat for 15-20 minutes at a time.
3. Always use a barrier (like a towel) between the heat source and your skin to prevent burns.
4. Check your skin regularly for signs of irritation or burns.

How often should you apply ice or heat to an injury? The frequency can vary depending on the severity of the injury and your individual response, but generally, you can apply ice or heat several times a day as long as you allow sufficient time between applications.

Treating Specific Injuries: Ice or Heat?

Different types of injuries may require different approaches when it comes to ice and heat therapy. Let’s look at some common injuries and the recommended treatment:

Sprained Ankle

For a sprained ankle, the initial treatment should focus on reducing swelling and pain:

• First 24-48 hours: Apply ice for 15-20 minutes every 2-3 hours.
• After 48-72 hours: Begin alternating between ice and heat therapy.
• Use ice after activity to prevent swelling.
• Use heat before activity to improve flexibility.

Muscle Strain

The treatment for a muscle strain can vary depending on its severity:

• Acute phase (first 24-72 hours): Use ice to reduce inflammation and pain.
• After the acute phase: Alternate between ice and heat, using ice after activity and heat before stretching or exercise.

Chronic Back Pain

For ongoing back pain, heat is often more beneficial:

• Use heat to relax muscles and improve flexibility.
• Apply heat before stretching or exercise.
• If there’s a flare-up with inflammation, use ice first, then switch to heat.

Can the same injury require different treatments at different stages? Absolutely. As an injury progresses from acute to subacute to chronic, the most effective treatment may change.

Combining Ice and Heat: Contrast Therapy

Contrast therapy, which involves alternating between ice and heat treatments, can be an effective way to manage certain injuries. This approach is thought to create a pumping action in the blood vessels, potentially improving circulation and reducing swelling.

How to Perform Contrast Therapy

To use contrast therapy effectively:

1. Start with heat for 3-5 minutes.
2. Switch to cold for 1 minute.
3. Alternate between heat and cold, ending with cold.
4. Repeat this cycle 3-5 times.

Is contrast therapy suitable for all injuries? While contrast therapy can be beneficial for many subacute and chronic injuries, it’s not recommended for acute injuries or those with active inflammation.

When to Seek Professional Medical Help

While many minor sprains and strains can be effectively treated at home with ice and heat therapy, there are situations where professional medical attention is necessary. Be alert for the following signs that indicate you should see a doctor:

• Severe pain that doesn’t improve with rest and home treatment
• Inability to bear weight on the injured limb
• Visible deformity in the injured area
• Numbness or tingling in the injured area
• Redness, warmth, or streaking extending from the injury site
• Fever accompanying the injury

How long should you wait before seeking medical attention if an injury doesn’t improve? If you don’t see significant improvement after 72 hours of home treatment, or if symptoms worsen, it’s time to consult a healthcare professional.

Understanding when and how to use ice and heat therapy can significantly enhance your recovery from common sports injuries. Remember, while these treatments are generally safe and effective, every injury is unique. If you’re unsure about the best course of treatment or if your symptoms persist, don’t hesitate to seek advice from a medical professional. With proper care and patience, most sprains and strains will heal, allowing you to return to your active lifestyle.

Listener Question: Ice or Heat a Sprained Ankle? | University of Utah Health

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Episode Transcript

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: This week’s listener question is with Dr. Emily Harold. She’s a sports medicine expert from the University of Utah and the question is: “Ice or heat for a sprained ankle?”

Treatment for a Sprained Ankle

Dr. Harold: That’s a very good question. I get this question a lot in clinic. So, typically, ice decreases blood flow to an area, which causes less swelling, whereas heat will bring blood flow to an area which can cause more swelling. Usually, in the first two to three days after an injury, we would recommend ice only. You put the ice on for about 10 to 15 minutes.

Make sure you put something between the ice and your skin so you don’t freeze your skin because you can then get freezer burn. Take the ice pack off and once your skin re-warms, you can re-ice the area. So you could ice it as many times as you want during the day as long as you follow those rules.

Three Days After Injury

Once it’s been about three days, you can put heat on the injury. Especially for muscle injuries, that tends to help warm up the area and make it a little easier to walk and get around during the day. The heat is also 15 minutes, put the barrier between the hot pad and your skin and let your skin go back to normal temperature before you would use heat again.

Typically, the rule of thumb for us is after three days, you would ice after you do an activity and you would heat prior to doing the activity. That way, you bring the blood flow before the activity and warm up the area. And then after you are done, you put the ice on the decrease on the information that might develop afterward.

Interviewer: How long is it until we can stop icing or putting heat on it?

Dr. Harold: Typically, I let pain be the guide. For a lot of people, within a few days, they don’t need to ice or heat the injury anymore, although for some people that have some persistent pain that will last for a few weeks. And they tend to heat before activity and ice at the end of the day.

Still in Pain After One to Two Weeks?

Interviewer: When is it time to go to the doctor if this doesn’t stop?

Dr. Harold: If it’s been about one to two weeks and you don’t feel there’s any difference in your pain, then I think it’s time to be evaluated.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at thescoperadio.com.

updated: July 18, 2018
originally published: January 26, 2017

When To Use Ice Or Heat — How To Treat Sprains, Strains, And Other Sports Injuries: Sports Medicine Oregon: Orthopedic Surgery

When To Use Ice Or Heat — How To Treat Sprains, Strains, And Other Sports Injuries: Sports Medicine Oregon: Orthopedic Surgery

Whether you’re on the playing field or in the house, the occasional bump, bruise, sprain or pang is inevitable. These injuries may be sudden or the result of overuse and gradual wear and tear. Fortunately, less severe aches and pains may not require professional medical attention. In fact, many common injuries can be effectively treated with ice therapy, heat therapy, or a combination of the two. However, knowing when to use heat or ice and whether to use ice or heat first can be tricky. In this post, we will explain the proper at-home care for many frequently asked sports injury questions, such as how to treat a sprained ankle and whether you should use heat or ice for muscle strain. Before we jump into treatment, it’s important to understand the symptoms and causes of many typical sports injuries.

Common Aches, Pains, And Soft Tissue Injuries

Sprains

Whether the result of a slip around the house or a misstep on the playing field, many of us have experienced a painful sprain or two. A sprain is a common sports injury that generally occurs in the wrists, knees, and ankles. Throughout the human body, tissues known as ligaments support joints by connecting bones to other bones. A sprain is the result of the tearing or stretching of one of these ligaments too far. Common sprain symptoms include swelling, pain, discomfort, and difficulty moving the affected joint or limb.

Strains

While ligaments connect bones to other bones, tendons attach muscles to bones throughout the body. Overexerting a muscle or stretching a tendon or muscle too far can result in a strain. Muscle strains involving the lower back, legs, and shoulders are common. Typical symptoms of strains include pain, general stiffness, weakness, swelling, muscular spasms, and difficulty moving the affected area.

Cramps

While ligaments connect bones to other bones, tendons attach muscles to bones throughout the body. Overexerting a muscle or stretching a tendon or muscle too far can result in a strain. Muscle strains involving the lower back, legs, and shoulders are common. Typical symptoms of strains include pain, general stiffness, weakness, swelling, muscular spasms, and difficulty moving the affected area.

At-Home Injury Care: What Is the Rice Method?

For years, the R.I.C.E. method — an acronym for rest, ice, compression, and elevation — has been an effective treatment for many common aches and pains. After suffering an acute injury, such as a mild sprain or strain, the RICE technique can help dull pain, minimize swelling, and expedite the recovery process. Over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDS) can also be used to help with pain and swelling.

R Is For Rest

After an injury, it’s imperative that the body is given time to heal and the best way to do this is to rest it. As painful as it may be to miss a workout or practice, pushing your body too far too soon can increase the severity of the injury and only prolong its recovery. After an injury, it’s important to limit any strenuous activities involving the limb or area. Crutches, splints, and bandages can be used to support injuries while performing weight-bearing movements.

I Is For Ice

It’s important to apply ice to the area immediately following an injury. Ice or ice packs will cause blood vessels to constrict and reduce blood supply to the injury. Reducing blood flow to the area minimizes swelling after an injury. Ice may be necessary for the first few days following an acute injury to prevent swelling.

C Is For Compression

Another reason to prevent swelling after an injury is to minimize pain, sensitivity, and also shorten the recovery time. Compression reduces inflammation by preventing blood and other fluids from accumulating around the injury. Different parts of the body will require different shapes and styles for the best fit but, no matter the area or injury, there are many types of compression gear available.

E Is For Elevation

The last step of the RICE technique is elevation. As a general rule, after an injury, individuals should try to keep the affected area higher than their heart. Elevating the injury above the heart will decrease the blood flow to the area, decreasing post-injury swelling, and aid the recovery process. It may be necessary to use a chair, bed, or pillows to prop the affected limb or area and achieve the correct elevation.

Can you walk with a torn meniscus? This depends on the severity of the injury. Many individuals are still capable of putting weight on the affected knee and even walking normally after a meniscus injury. In fact, many athletes can even continue playing after a meniscus injury. That said, initial levels of functionality can be deceiving, as it may take a few days for knee pain, swelling, and stiffness to set in after the injury occurs.

If you are having difficulty extending your leg following an injury, or if your knee locks up, this could be the result of a common meniscus injury known as a bucket handle meniscus tear, characterized by loose cartilage adrift in the knee. Knee instability and locked knee symptoms, including the knee locking up during normal movement, are all common following a meniscus tear.

During the initial trauma, many individuals report not only feeling a pop in the knee, but to also hearing an audible popping sound. This pop can also coincide with debilitating pain. Knee popping and locking is an unsettling experience for many, but this is to be expected with more severe meniscus tears. Your doctor will use imaging testing, such an X-ray or magnetic resonance imaging (MRI), to accurately diagnose your knee injury.

How To Treat A Sprain, Strain, And Stiffness — When To Use Ice Or Heat?

Knowing exactly when to use heat or ice can shorten recovery time and help with chronic aches, pains, and stiffness. Treating an injury can be tricky and not all sports injuries or conditions will require strictly ice or heat therapy. In some cases, both ice therapy and heat therapy can play a crucial role in the rehabilitation process. Generally speaking, ice therapy is more appropriate for new injuries, like sprains and strains, whereas heat therapy is typically better for treating chronic conditions.

The RICE method is useful immediately following a sprain or strain and can also help with swelling or sharp pain following rigorous activity or exercise. Heat is often best for tight muscles, sore muscles, as well as the stiffness and pain associated with arthritis. Heat can also be used following an acute injury to increase blood flow once the swelling has subsided. Remember, though, that applying heat too soon following an acute injury can increase swelling. After sustaining a sudden injury, ice therapy should be used for the first 24 to 72 hours and, after that, individuals can transition to heat therapy in order to increase blood flow to the area.

Certainly, there are exceptions to these rules of thumb and some injuries may respond more appropriately to a combination of both ice and heat therapy. A recent study determined that both ice and heat therapy effectively reduced damaged muscle tissue following strength training, however, cold therapy was more effective for treating pain immediately following a workout and up to 24 hours later.

Each injury will require different care and there are circumstances when ice or heat may be inappropriate for a specific injury or condition. For example, using heat on a new injury may promote blood flow to the area and increase the risk of swelling. Using ice for lower back pain related to muscle stiffness may actually only exacerbate the offending stiffness. Both ice and heat play an important role in the recovery process after an injury and there are a few guidelines to follow for effective ice and heat therapy.

How To Perform Ice Therapy

Ice therapy is typically used for shorter periods of time than heat therapy. Effective cold therapy involves multiple daily treatments, up to 20 minutes at a time. Remember, icing a sprained ankle, strain, or any injury for longer than 20 minutes at a time is not recommended. Some individuals may need just a single daily treatment while more severe sprains and strains may require multiple daily ice therapy applications. To prevent skin burn, individuals should place a layer of material between the skin and the ice pack or ice product. Wrapping an ice pack or bag of ice in a towel to prevent direct contact with the skin generally does the trick.

How To Perform Heat Therapy

There are many products on the market that penetrate deep tissues for effective heat treatment. Whether dry heat or moist heat may be more appropriate depends on the condition. A heating pad is an example of a dry heat source, whereas a warm bath is a popular moist heat therapy. Research has shown that moist heat may be superior to dry heat when it comes to penetrating deeper tissues. Therefore, moist heat may be more effective for treating denser muscle tissues, such as the quadriceps. During heat therapy treatments, it’s important to use a comfortable level of heat to minimize the risk of burns. When it comes to a warm soak in a hot tub, whirlpool or bath, the US Consumer Product Safety Commission does not recommend soaking in temperatures in excess of 104 degrees Fahrenheit Heating pads or heating packs should be wrapped in a towel or layer of fabric to prevent direct contact with the skin.

While heating pads and packs may be ideal for wider areas such as the lower back, smaller joints may require other types of heating products for optimal treatment. For example, those suffering from arthritis pain may choose to fully submerge the joint in a paraffin bath. While minor aches and pains may benefit from short 15 to 20 minute treatments daily, moderate symptoms may need extended treatment. Those with chronic muscle soreness may see good results from a soak in a warm bath for an hour or two.

(Note: Heat therapy may not be appropriate for people who are pregnant or people with peripheral vascular disease, heart disease, hypertension, diabetes, deep vein thrombosis, and other conditions.)

Frequently Asked Questions: When Do You Ice And When Do You Heat?

Determining when to use ice or heat therapy can be complicated. To assist, we’ve answered below some of the most frequently asked questions about when to ice and when to heat acute injuries and chronic conditions.

Should I use ice or heat for back pain?

Heat therapy is particularly helpful with chronic conditions, especially muscle stiffness and soreness. Localized stiffness may benefit from heating packs while regional stiffness and denser tissues may respond better to a warm bath. If the lower back pain is the result of a recent injury, such as a muscle strain, it’s best to follow the R.I.C.E. method for the first few days then, after about 72 hours, transition to heat therapy.

Should I use ice or heat for pulled muscles?

A pulled muscle should first be treated using the R.I.C.E. method. During the first 72 hours, heat should be avoided to prevent increased swelling and inflammation. After about 72 hours, heat can be incorporated into treatment to increase blood flow and aid the overall healing process.

Should I use ice or heat for swelling?

After an acute injury, ice should be used to minimize swelling for the first two to three days. After this period, heat can be used to increase blood flow and assist the natural healing process. Applying heat too early may cause additional swelling by increasing blood flow to the injury.

Should I treat a sprained ankle with ice or heat?

A sprained ankle will require both ice and heat at different points in the recovery. Initially, treatment will focus on rest, ice, compression, and elevation. After about 48 to 72 hours — or once the swelling has satisfactorily decreased — heat can then be used to increase blood flow to the injury and aid your recovery.

Should I use heat or ice for muscle spasms?

Heat therapy increases blood flow and this improved circulation may help with muscular spasms throughout the body. Massage and stretching may also alleviate pain and discomfort associated with a spasmodic muscle.

Should I use ice or heat for neck pain?

Many patients ask whether or not to use heat or ice for stiff neck muscles. Neck pain associated with chronic pain, general muscle soreness, or stiffness should be treated with heat therapy. However, a new injury usually calls for the RICE method to be used for the first two to three days, and then individuals may transition to heat therapy.

Should I use ice or heat for shoulder pain?

For new or acute injuries, the RICE technique is recommended for the first 24-72 hours. Once swelling has subsided, heat therapy can be used to help increase blood flow to the area and aid recovery. Heat therapy can also be used to help with the stiffness, aching, and general pain associated with a chronic condition, as needed.

Should I use ice or heat for knee pain?

The type of knee injury will help determine the proper ice or heat regimen moving forward. For new acute injuries, the RICE method should be used immediately following an injury, and then heat can be applied after two to three days to increase blood flow. For chronic injuries, pain, stiffness, and soreness without swelling, heat may be more appropriate. Heat therapy may help with arthritis, knee pain, and stiff joints by using heat packs, pads, and submerging the affected area in warm water. In some cases, gel packs may be more effective than traditional heat packs, due to their ability to form around the joint and penetrate tissues.

Sports Medicine Oregon — Acute Injury And Chronic Pain Specialists

The RICE method, ice therapy, and heat therapy may relieve pain and discomfort associated with many common aches and pains, but more severe injuries and chronic conditions will require medical intervention. At Sports Medicine Oregon, we can provide the latest conservative care treatments at our state-of-the-art facility, with services ranging from outpatient physical therapy and the latest regenerative injections to minimally invasive arthroscopic surgery. If you are dealing with a nagging sports injury or a chronic condition, our experienced medical team will tailor a specific treatment strategy based on your specific injury or condition to help you live the active, pain-free lifestyle of your dreams.

Remember, we update our Sports Medicine Oregon blog monthly, so be sure to tune in often to stay up-to-date on the latest sports medicine news and views!

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Ankle sprain: first aid, treatment, symptoms

Ankle sprain can be called one of the common household and sports injuries. The ankle is the ankle joint located around the heel bone. With the help of ligaments in this place, the bones are connected to each other and the muscles of the lower leg and foot are attached. Frequent stretching of the ankle ligaments leads to a loss of their elasticity. After receiving such an injury, it is recommended to seek first aid at a medical facility.

Causes of injury

Sprained ankles can be caused by:

• bending the foot to the side when walking or running;
• falling or landing on the heel while jumping;
• foot reversal;
• twisting of the foot on an uneven surface or when the foot enters a hole;
• reversal of the foot during sports.

Often such injuries occur in athletes during training. Ankle sprains in children and adolescents may be due to their flat feet or clubfoot. Adults who have weak joints or impaired coordination of movements also suffer from similar injuries. You can sprain your ankle, even just going up or down the stairs or badly twisting your leg. This often happens with lovers of high heels.

Sprain symptoms

The main symptom of this injury is a sharp pain in the ankle area. Immediately or after some time, edema appears in this place. You can also observe redness of the skin or the appearance of a hematoma. It hurts to step on the leg, walking after the injury is difficult.

The symptoms of an ankle sprain will depend on the extent of the injury. The more ligaments that are stretched will be damaged, the higher the degree of injury.

1. If the pain is mild and the sprain is slight, the pain subsides quickly and there may be some swelling.
2. Moderate accompanied by severe pain, swelling and slight bluing.
3. In severe cases, tendon and ligament rupture may occur.

In any case, a doctor’s consultation will be required to ensure that there are no other injuries.

If the pain only increases during the first 2 hours, then there is a possibility of a more serious injury – a torn ligament or a fracture. In this case, you should immediately seek medical help.

First aid for sprained ankle

What is the first thing to do if this injury occurs? It is necessary to know what first aid should be provided to the patient if he has signs of sprain in the ankle area.

First of all, ice must be applied to the damaged area for 15 minutes. This will reduce pain and avoid severe swelling. If it is ice, then it is better to wrap it in some kind of cloth.

If the pain is very severe, you can take 1 tablet of pain reliever such as Aspirin, Paracetamol or Ibuprofen.

The injured foot must be immobilized, you can fix it with an elastic bandage, but not too tight so as not to disturb the blood circulation.

After this, the patient must be sent to the hospital to be examined by a doctor.

Treatment of sprains

Before prescribing home treatment, the doctor examines the injured leg and prescribes an x-ray. The specialist palpates the foot and checks its mobility. This is necessary in order to make sure that there are no fractures or displacement of the bones. If necessary, an ultrasound examination and computed tomography are prescribed. Only after a thorough examination, the doctor can make an accurate diagnosis and prescribe the necessary treatment.

After the specialist confirms that this is a sprain, the patient is advised to provide complete rest to the injured leg. It is best if the patient stays in bed for the first couple of days in order to minimize the load on the injured leg. These days, it is necessary to periodically apply an ice compress to the ankle. The compress is applied for about 30 minutes, and then a break is taken for about an hour. There should be at least 5 such procedures per day.

If there is swelling, the leg from the toes to the middle of the lower leg should be wrapped with an elastic bandage, but not very tightly. When the swelling subsides, the bandage can be removed. Lying in bed, a cushion or pillow should be placed under the leg so that the ankle is above the level of the heart. This will help drain fluid from the injured area. For serious sprains, the doctor may apply a plaster cast for 2 weeks.

Anti-inflammatory gels or ointments, such as Ibuprofen or Fastum Gel, are applied to the injured area of ​​the leg to quickly heal a sprain.

After 5 days, when the main signs of stretching disappear, the doctor prescribes physiotherapy procedures – magnetic therapy, ultrasound, UHF.

After the edema and hematoma disappear, the following are prescribed:

• thermal procedures;
• heating with salt;
• paraffin applications;
• warming ointments such as Kapilar or Indovazin.