With summer now in full swing, 4th of July coming up, and everyone going outside, biking, playing, and being outdoor “weekend warriors”, we thought this would be a great time to feature this article. When to use heat or ice is extremely important because if you use them at the wrong time they can actually do more harm than good. Here’s the “skinny” ————

The first general rule is to ICE AN ACUTE INJURY and HEAT A CHRONIC INJURY. When you are first injured, your body’s natural response is swelling and inflammation. Your blood vessels expand in order to rush more blood to the area to begin to immediately start the healing process. You DO NOT want to use heat at this time. Heat will only cause even more swelling and inflammation — and more pain. You want to use ICE within the first 24 hours of an injury. Ice allows the blood vessels to contract, reducing inflammation and bringing down the swelling, in addition to relieving pain by calming irritated nerves. Never apply ice directly to the skin, as it could cause frostbite – yes, really. Ice or cold packs should be wrapped in a damp wash cloth or towel, or just use a bag of frozen peas – again, really. Apply for 10 to 20 minutes every two hours during the first 72 hours.

HEAT is most useful for chronic injury/conditions, as it increases blood flow. Heat should NOT be used immediately after an injury, as it may ultimately increase pain and swelling. Sitting in a tub of hot water may feel good, however, the next day you will likely feel more pain and stiffness due to the increased inflammation it has caused. Apply heat beginning 72 hours after an injury, and make it MOIST heat, as this is most ideal for healing. Either apply a warm, wet towel or submerge yourself in a tub for 10 to 30 minutes two to five times a day. Warm rather than hot should be used to avoid the risk of burns, and heat should NEVER be applied for an extended period of time or when you are sleeping. Heat is also useful in cases of chronic injury, such as overuse injuries in athletes, shoulder impingement syndrome, bursitis and tendonitis.


A Vitamin D theory that might not wash with you……………….There is a theory gaining support among some doctors and researchers that we are literally washing Vitamin D – which we get from the sun – down the drain!!

Consider for a moment how sunlight converts to Vitamin D in the first place — on the skin! You see, Vitamin D3 is actually not a vitamin at all. It is an oil-soluble steroid hormone. When your skin is exposed to ultraviolet rays, it converts a form of cholesterol into Vitamin D3 — but not instantly. It takes some time to make its way through the skin and into the bloodstream. How much time is hard to say for sure. Possibly it’s just a couple of hours; or it could be as long as 48 hours. Science is still researching that.

Perhaps after outside sun exposure we should just rinse our body and not use excessive soap applications until later.

The truth is that until the advent of indoor plumbing and hot water heaters, humans never showered as often as we do now. For most of us, that is at least once a day, and as many as twice a day or more when we go to the gym or the beach or pool.


A bursa is a pouch filled with a small amount of lubricating fluid that provides cushioning between a bone and tendon, ligament, muscle or skin, which allows them to slide smoothly over the bone as it moves. Bursae are located wherever tissue and bone meet. When the tissue of the bursa becomes swollen and inflamed, it causes bursitis.

Though bursitis can occur anywhere in the body where bursae are located, the most common areas are the shoulder, hip, knee and elbow. Bursitis is often caused by excessive repetitive motion, such as hitting a tennis ball, vacuuming or hammering, for example, or by leaning on your elbows at your desk.

Traumatic injury, such as a fall or a car accident, can also lead to bursitis. If bacteria get inside the bursa via a wound, infection may result, leading to heat, redness, fever, chills, swelling and pain, and excess fluid will collect in the bursa, causing a large bump to form around the area. Additionally, those who suffer from gout, diabetes, or rheumatoid arthritis are at greater risk for contacting bursitis.

The first treatment for bursitis is rest, ice, compression and elevation, or “RICE”. Rest the area as much as possible, keep pressure off of it as much as possible, cushion the area if necessary. Apply ice and wrap an elastic bandage around the area. You can take NSAIDS to decrease inflammation and reduce pain.

Bursitis usually heals in a matter of weeks or months, depending upon its severity. Dr. Fiscella can recommend treatments and exercises to help restore range of motion.