When we are dealing with an injury that has occurred in the last 24 to 72 hours there will likely be signs and symptoms of inflammation.

S.H.A.R.P- stands for Swelling, Heat (warmth), Altered function, Redness, Pain. These are tell tale markers of inflammation. When inflammation

is present, it means that the body is trying to protect itself to do no further harm.

Swelling: Broken blood vessels and chemical mediators in the blood will respond to the injury site by increasing circulation and flooding the

injury site with exudate (swelling). This is an attempt to splint the area so that it doesn't move, and it is the first response and step towards healing.

Heat: The injury will likely feel warm or even hot depending on what has been damaged. Generally speaking, soft tissue injuries such as ligaments,

muscles, tendons, and joint capsules, if strained or sprained, will feel warmer due to the increased swelling and perfusion of blood to the injured site.

Altered function: As a result of swelling, pain, and potential damage to supportive structures of joints, the relative function of the muscle, ligament,

or joint will be compromised, and hence its function will be compromised and altered. i.e.: limping after spraining an ankle.

Redness: As a result of the flooding of blood to the area, depending on whether any blood vessels were damaged, some injuries will show

discolouration as a result of the increased circulation. Hence the redness.

Pain: This is likely the most universal symptom of most injuries, even minor ones. Pain is precipitated by a number of factors. The chemical mediators

such as prostaglandins, and bradykinins which are inflammatory agents and are sent to the injured site to help protect the injury as part of the inflammatory

process. Also, there are tiny little nerve endings in most tissues such as ligaments, joint capsules, tendons, and the junctions where the muscles connect with

the tendons. These little nerves are called nociceptors. Their response to the chemical mediators in the blood, increased pressure around the joint due to the swelling, and are irritated or damaged in the injured tissues themselves. Nociceptors are one of main our pain sensors in the body. Pain will usually persist when the other inflammatory factors are still present or active.

Now that we have described the main indicators for using cold or an ice application, the following are some recommendations for cold applications to treat most soft tissue injuries.

If any of S.H.A.R.P is present at your injury, it is still an acute injury and will require an ice application.

	When icing, ensure that any cuts or abrasions are cleaned, covered and dressed in and around the injury.
	Elevate your injury if appropriate.
	You should place a paper towel or a wet thin cloth as a protective barrier over the area you are going to apply the ice.
	Ice applications can vary, but some common applications are ice bags, a bag of frozen peas or veggies out of the freezer, freezer gel packs, or even ice cubes in a wet cloth,
	if that is all you have. If available, ice baths are wonderful for lower extremity injuries. The temperature should be approximately 55 degrees Fahrenheit.
	The timing of the ice application is most important. Ligaments and more superficial injuries can stand 15 minutes per hour. Deeper muscle type injuries can benefit from no more
	than a 20 minute per hour application.

Use of Heat for an injury?

As a rule, if any signs or symptoms of S.H.A.R.P are present even if it has been beyond the 72 hour acute period, heat should not be applied.

	Heat should be applied with most chronic, musculoskeletal injuries. Stiff muscles, immobile spinal tissues, or can also be used in concert with
	ice application in something called "contrast bathing", which we will discuss at another time. Sore, still muscles are generally indicated for heat applications.
	Heat applications can vary from hot tubs, moist heat packs, hot showers, thermal blankets, and mild exercise. Hot or warm water applications should hover around
	105 degrees Fahrenheit. Stretching or mobility exercises are usually indicated after the application when indicated.

if you have any specific questions about treating with ice or heat for your injury, email us at : heatstherapy@hotmail.com

Jean LaFleur CAT(c), CSCS, NSCA-CPT, B.HK, Dip SIM