Should You Use a Hot or Cold Pack on a Sprained Ankle?

QUESTION: Please settle a bet for me. I say that you should apply hot packs
to a sprained ankle, but my husband insists that the proper treatment is an
ice pack, like they use for football players who are injured. What is the
correct procedure?
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ANSWER: Far be it from me to interfere in a marital disagreement (what did
you bet?). Actually you may both be considered right; it's all a matter of
timing. All joints, such as ankles and knees, are surrounded by ligaments and
tendons, which are built of a tissue in which a protein, collagen, is a
primary building block. Collagen is an elastic, rubber-like material which
stretches like a rubber band. And just like a rubber band, pull it too far
and it tears, and the blood vessels which run through the tissue rupture,
spilling blood cells and fluid into the surrounding structures. You can
observe this as a bruise, swollen and discolored. When exposed to cold, the
collagen becomes stiff, and the tissue cell activity is reduced. This in turn
reduces the flow of blood to the area, and reduces the swelling and internal
bleeding. In addition, cold can lower nerve activity, reducing pain and
numbing the treated area. Heat, on the other hand, increases the flexibility
of collagen, allowing the tendons and ligaments to relax. It also increases
blood flow and speeds the healing process. Thus the correct sequence of
events is as follows: Cold is applied initially to an injury and throughout
the acute phase, which lasts about 48 hours. Then it is time for the hot
compresses, heating pads or heat lamps. Hot water bottles are effective, but
the water temperature should be maintained at about 104 F (about 40 degrees
Centigrade.) I leave it to you to figure out who won the bet.