Ice or Heat?

One of the most common questions I hear is, “should I put ice or heat on it?

When to ice:ice injury

Any new injury is a good candidate for ice. If there is swelling or warmth over the area, ice is a good idea. The cold will help to constrict the blood vessels in the area. This will limit the amount of swelling by decreasing the blood and fluid released into the damaged tissue. The ice will also help to slow nerve impulses. The numbing effect will decrease pain.

Whenever there is a new injury, the body releases chemicals in the area to limit the area of damage and to clean up the injured cells. Some of these chemicals trigger pain signals to be sent to the brain. By applying ice to the area, you limit the amount of these chemicals and the pain signals.

Because blood vessels can also be injured and because an injured area is used and moved less, the swelling that is allowed to accumulate may take awhile to dissipate. The extra fluid volume creates pressure and decreases mobility. That is why it is so important to ice right after something is injured.

Ice for prevention:

  • After a car accident, the victims may not feel pain initially due to the adrenaline released and other factors. Even if you feel fine, it is not a bad idea to put some frozen peas on your neck for 15 minutes when you get home.
  • After a hard workout. Many athletes will ice a joint they know gets a lot of work to prevent inflammation and injury. Example: baseball pitcher icing his shoulder and elbow when he leaves the game.

When not to ice: it hurts more than the expected uncomfortable nature of ice, Raynaud’s Syndrome, neuropathy or numbness. Do not apply chemical ice packs directly to skin.

When to heat:

Heat can be very comforting. It tends to be relaxing and can relieve pain. If an injury is more chronic and/or involves a muscle spasm, heat can be very helpful. It dilates the local blood vessels and improves blood flow to an area. This can help to pump out toxins and provide an influx of oxygen and nutrients to injured cells.

Paraffin or hot wax baths can be very soothing to arthritic hands and feet. Heated car seats can relieve back pain caused by sitting still on a long drive (I am hoping my next car will have this feature!). Hot tubs can relax the mind and the body.

Using heat before stretching or a workout can help to loosen muscles and prepare them for movement. This is particularly important for individuals that are unable to perform an active warm up like walking and biking.

When not to heat: tumor, infection, inflammatory condition, swelling, neuropathy, heart condition, high blood pressure. [Large hot packs and hot tubs can alter demands on the heart. Consult your physician first.] MS and some arthritic conditions will not respond well to heat. Do not fall asleep with your hot pack. Even the patches from the drug store can cause burns.

When to use both

There is a treatment called contrast that involves using both heat and ice. This seems to work well with sub-acute injuries. That is, injuries that are over 48-72 hours old and injuries/surgeries that do not feel warm to the touch and where the swelling is stable/not increasing. The general rule that I learned is that you should start and finish with cold. You can use each 3-5 minutes and alternate to the other for another 3-5 minutes. This process can help to pump out stagnate swelling. If you are using a double sink or two buckets, feel free to do slow movements in the warm tub to decrease stiffness.


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