Ice or Heat?

One of the most common questions that I get on a daily basis is: “Should I use heat or ice?’

There is no simple answer for every individual or condition, and there is certainly some controversy with several guidelines, but there can be some common sense approaches to use. Both ice and heat can reduce pain, at least in the short term. However, they are used very differently based on their physiological effects. 

Heat is often used in various ways by practitioners, but for this context we will only discuss it in relation to home use. Similar to ice therapy, heat helps with short term pain. Unlike ice, heat is a vasodilator, which means that it increases the diameter of blood vessels and increases blood flow. This allows oxygen and nutrients to be delivered quickly to tissues and carbon dioxide and wastes to be transported away. These physiological effects allow for muscle tissue to relax, improves joint stiffness, and can reduce muscle spasm. However, it has limitations and potential for harm if used inappropriately. Shortly after an injury, the body produces swelling and inflammation. During this recovery period, heat is much less likely to reduce swelling and inflammation, and perhaps can make it worse, thus producing more pain and possibly slowing recovery. Generally, heat is often applied for conditions, such as:  rheumatoid arthritis, chronic osteoarthritis, fibromyalgia, muscle pain and tightness, headaches and migraines. Please note that muscle spasm or muscle tightness is often secondary to inflammation, so talk to your health practitioner to verify that using heat is a good choice for your individual condition.  The general rule for applying heat: use heat for chronic pain, muscle tightness and joint stiffness in order to warm up tissues before activities, stretching, and exercise, and at the beginning of the day.

Ice therapy or cryotherapy is a vasoconstrictor. This means that the diameter of blood vessels is reduced, thus decreasing blood flow. Because the flow is reduced, ice helps with decreasing inflammation and swelling. Of course, this reduces pain, at least for the short term. But, it also often improves healing time for acute injuries because the damaging effects of the inflammation and swelling is minimized. Ice is most often used following injuries, but can be used just as much for aggravations of previous injuries. Similar to heat, cryotherapy can also be effective for certain headaches and muscle spasm. As a chiropractor, I prescribe the use of ice more than heat because most of the conditions I encounter deal with the effects inflammation. Unfortunately, ice tends to be more uncomfortable. Prior to the desired numbing effects, burning or achy pain is common at the site as the tissues cool. Just as with heat therapy, please discuss using ice with your health practitioner make sure that it is appropriate for your condition.  If you have skin areas with less sensation or circulation, caution must be made with both ice or heat, as there is more risk in applying it for too long. The general rule for applying cryotherapy: use ice with acute injuries or aggravations in order to to reduce swelling and inflammation; and especially, after activities and exercise, and at the end of the day.

There are a wide range of ice packs and heat packs. While moist heat is most effective to heat tissue, hot water bottles and moist heat packs can be more likely to retain heat and cause skin burns. For home use, an easy method is the gel packs that contour the body and can be microwaved for heat or thrown into the freezer for ice therapy. This takes up less space in the freezer, is generally quite safe, and can be re-used multiple times. Please follow the instructions carefully, as they may vary. Use a thin towel layer to create separation from the pack and the skin. This can prevent burns and frostbite. Generally, apply for 10-20 minutes, depending on the body region. For example, the back of the neck would be 10-15 minutes, while the low back would be 15-20 minutes for ice or heat. Laying in a non weight-bearing position is preferred while applying the pack. Usually I recommend hourly applications at  most. Again, caution is advised for heating or icing areas with less sensitivity or falling asleep while heating, as burns are possible if heating for too long. Below are the gel packs that are available in our office that can be heated or frozen. We will follow up with more articles that discuss this topic further. Please call our office if you have any questions or comment below.