Most people with pre-diabetes or insulin resistance don’t know it yet.More than 60% of the South African population are clinically obese, and roughly one in every 17 South Africans are diabetic! This is a huge problem if we consider that obesity and diabetes are the leading causes of heart disease, dementia, cancer and premature death in the world. Even if you do have perfectly normal blood sugar levels, you may still be insulin resistant. This article should help answer some questions: What is insulin resistance? How can I identify if I am insulin resistant? And, what can I do to reduce my risk?

To treat with Heat or with Ice???


Bronwen Henchie (BSc Physio)
One question that I get asked most often by my patients is “Should I ice this condition or should I apply heat?”
It is very important to understand when to apply ice and when to apply heat because using the wrong thing
can cause greater discomfort and longer healing times.

Ice / Cryotherapy


The use of ice has many benefits. It has been shown to decrease pain (and
therefore decrease the need for medication), decrease bleeding by causing
vasoconstriction, increasing range of movement and improving sleep. (Morsi E
2002, Speer et al 1996)


  • Acute injuries: especially if there is pain, swelling and redness present
  • Post knee surgeries, shoulder surgeries (Speer et al 1996), wisdom teeth removal
  • Overuse sports conditions : ice must be applied after (and not before) activity
  • The following conditions respond well to ice: sprains, muscle tears, tendinopathies, rheumatoid

Ice application can come in different forms. These include ice packs, ice blocks wrapped in cloth, pack of
frozen peas, continuous flow cold therapy.
The benefits of ice have been shown to be improved if applied in combination with compression (Schroder et
al 1994)

How long and How often:
Ice should be applied for 10 minutes, 3 – 6 times per day.

Heat / Thermotherapy



  • Chronic conditions: especially muscle aches, neck & back pain
  • Overuse sports conditions: heat must be applied before activity
  • Examples: lower back pain, tension headaches, muscle spasm, stiffness, frozen shoulder

There are two types of heat application. Local application via microwave heat packs (wheatbags) or hot water
bottles can be used. Systemic or immersion heating can also be used; this can be done in the form of hot
baths, hot showers, steam rooms or saunas

How long and How often:
The general consensus is to apply heat for 15 – 20 minutes, 2 – 3 times a day.

Contrast Therapy


Contrast therapy is indicated for oedema or swelling (especially in sub-acute ankle injuries), sprains and soft
tissue injuries.
Contrast baths are contraindicated in the acute inflammatory phase and therefore shouldn’t be used in the
first 24 – 72 hours after an injury or surgery as the heat application can cause an increase in blood flow and
thus an increase in bleeding in the area.

Traditionally contrast therapy is applied as a full immersion of the body or limb into ice water and then into
warm water. This concept of alternating hot and cold can be applied locally using ice and heat packs.
The theory behind contrast therapy is that the decrease in temperature with the ice causes a vasoconstriction
(narrowing) of the blood vessels. When the heat is applied, there is an immediate vasodilation (widening) of
the blood vessels which should result in a pumping action as the blood vessels dilate and constrict. This
unfortunately has not been able to be proven in any recent research.

How long and How often:
The recommendation is that the heat application be three times more than the ice application. For a full body
ice immersion, it is not recommended to last more than 1 minute and therefore the heat application will be 3
minutes. This can be repeated continuously for 20 – 30 minutes.



  • Make sure the sensation of the area to be treated is intact
  • Do not leave ice or heat on for an extended period of time as it can cause damage to the tissue
    (never fall asleep during its application)
  • It is important not to use heat or have a hot bath after an acute injury as it can increase the blood
    flow to the area which can caused increased inflammation and prolong the recovery period.




  • Bleakley C, McDonough S, MacAuley D 2004 The use of ice in the treatment of acute soft-tissue injury: a
    systematic review of randomized controlled trials. American Journal of Sports Medicine 32(1): 251-261
  • Higgins D, Kaminski TW 1998 Contrast therapy does not cause fluctuations in human gastrocnemius
    intramuscular temperature. Journal of Athletic Training 33(4): 336-340
  • Levy AS, Marmar E 1993 The role of cold compression dressings in the postoperative treatment of total knee
    arthroplasty. Clinical Orthopedic and Related Research 297: 174-178
  • Levy AS, Kelly B, Lintner S, Speer K 1997 Penetration of cryotherapy in treatment after shoulder arthroscopy.
    The Journal of Arthroscopic and Related Surgery 14(4): 461-464
  • MacAuley DC 2001 Ice therapy: how good is the evidence? International Journal of Sports Medicine 22(5):
  • Mayer JM, Ralph L, Look M, Erasala GN, Verna JL, Matheson LN, Mooney V 2005 Treating acute low back pain
    with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial. Spine
    Journal5(4): 395-403
  • Morsi E 2002 Continuous-flow cold therapy after total knee arthroplasty. Arthroplasty17(6): 718-722
  • Myrer JW, Measom G, Durrant E, Fellingham GW 1997 Cold- and Hot-Pack Contrast Therapy: Subcutaneous
    and Intramuscular Temperature Change. Journal of Athletic Training 32(3): 238-241
  • Schroder D, Passler HH 1994 Combination of cold and compression after knee surgery: a prospective
    randomized study. Knee Surgery, Sports Traumatology, Arthroscopy 2(3): 158-165
  • Speer KP, Warren RF, Horowitz L 1996 The efficacy of cryotherapy in the postoperative shoulder. Journal of Shoulder and Elbow Surgery 5(1): 62-68


Bronwen Henchie
BSc Physio (Wits)