From the Guidelines
For a contusion, cold application, specifically ice therapy, is the recommended initial treatment to acutely decrease pain and swelling. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, cold therapy has been shown to improve pain scores and reduce edema in the acute time period. The guidelines suggest using a bag filled with ice and water surrounded by a damp cloth to achieve the greatest tissue cooling, and recommend limiting the duration of cold application to 20 to 30 minutes for 3 to 4 times daily.
Key Considerations
- Ice should not be placed directly on the skin to prevent cold injury
- The use of refreezable gel packs or ice alone is also acceptable, but they do not cool the area as effectively as an ice and water mixture
- Cold application has not been demonstrated to improve function or time to recovery, but it can help reduce pain and swelling in the initial stages
Treatment Approach
- Apply ice therapy for the initial 24-48 hours after injury to reduce swelling, inflammation, and pain
- After 48 hours, when the initial swelling has subsided, heat therapy can be considered to increase blood flow to the injured area and accelerate healing
- Throughout recovery, keep the injured area elevated when possible, take over-the-counter pain relievers like acetaminophen or ibuprofen according to package directions if needed, and avoid activities that cause pain.
From the Research
Ice or Heat Therapy for Contusion
- The use of ice or heat therapy for contusions is a common practice, but the most effective approach is still debated 2, 3.
- Cryotherapy, or the use of ice, has been shown to reduce pain and inflammation in animal models of muscle injury, but the evidence in humans is limited 2.
- The application of cryotherapy must be repeated to overcome the limitation of inadequate duration of application, and the timing of treatment is crucial to limit secondary tissue damage 2.
- On the other hand, heat therapy has been shown to increase blood flow and reduce pain in patients with musculoskeletal injuries, including contusions 4, 3.
- A study on patients with chronic neck pain found that low-level continuous heat therapy significantly reduced pain and improved range of motion 4.
- However, the evidence for the use of heat or cold therapy in acute musculoskeletal injuries, including contusions, is limited, and more high-quality randomized controlled trials are needed to determine the most effective approach 3.
- In terms of pharmacologic management, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute pain, including pain from contusions 5, 6.
- Topical NSAIDs may be recommended for non-low back, musculoskeletal injuries, including contusions 5.
- The choice between ice and heat therapy may depend on the individual patient's needs and the specific injury, and further research is needed to determine the most effective approach 2, 3.