ICE vs HEAT: Which to Use for Pain & Injury?

with Michael Racca, PT, MSPT, CEAS

This is one of the most common questions patients ask. To complicate the matter, New York Times articles like “Why Ice May Not Be Good for Sore Muscles” may further confuse people. This article raised some excellent points based on recent research about when, and more importantly, when it may not be good to use Ice.

When to use Heat:
Heat can provide temporary relief of stiffness, relax muscles, and stimulate circulation. Heat increases tissue temperature and blood flow by dilating blood vessels, drawing extra nutrients into the area to assist in the recovery and healing process. Heat therapy is most commonly applied with a moist hot pack, but can also be applied with whirlpools or paraffin baths.

When Not to use Heat:
Heat should never be used on acute injuries until the swelling is controlled. Heat draws fluids into tissues and can increase swelling and inflammation. Do not use heat over swollen tissues or redness. Do not use heat before vigorous exercise. Your muscles may be too relaxed to perform safely. An active warm-up is a better option.

How to use Heat: 
Typical treatment times for heat applications are 15-20 minutes. It takes heat a minimum of 15 minutes to penetrate tissues to reach therapeutic temperatures. Moist heat penetrates more deeply than dry heat and will not dehydrate tissues so circulation is improved.

Precautions:
Follow product instructions carefully. Heat can burn and damage tissues if used improperly. Do not use heat over areas of numbness or decreased sensation.

Most sources agree that alternating the use of heat and ice has not been shown to have any more benefit than applying ice or heat alone. The above information has been commonly reported by a variety of sources, although new research is constantly challenging previous information. Please remember that if you have any questions about using Heat or Ice, you should consult your licensed healthcare practitioner.

In other cases, ice will be the desired “go to” for relief.

When to use Ice:
Ice or Cold therapy is most often used for acute injuries. When applied immediately after an injury, cold treatment can reduce tissue damage and inflammation. Ice also relieves muscle spasms, and can reduce post-exercise soreness. Cold therapy can be applied with ice packs, cold whirlpools, or cold sprays, but ice massage has been shown to be the most effective form of cold therapy.

When Not to use Ice:
Do not use over areas of numbness or poor circulation. Elderly people, young children, and people with diabetes must use caution with cold.Recent research indicates impaired muscle strength and power immediately after icing, so it should not be used immediately before exercise or sports.

How to Use Ice:
The first 72 hours after an acute injury, you should only use cold treatments. Treatment time varies depending on several factors, including the size of the treatment area, the type of cold therapy applied, and the size of the individual.For example, a very thin person requires less treatment time because the cold does not need to penetrate through as much soft tissue.

You’ll know when you’ve had the cold on long enough, by monitoring the 4 stages of cold treatment:

Stage 1 is the obvious cold feeling
Stage 2 is a stinging or burning sensation
Stage 3 is aching
Stage 4 is numbness

It can take 5-15 minutes to reach all four stages. Ice should be removed when numbness is reached. For acute injuries, apply cold immediately for 10 to 20 minutes. Repeat the cold application 3-4x a day for the first 72 hours after an injury. To reduce post-exercise soreness, apply cold immediately after exercise for 10 to 20 minutes. For chronic discomfort, apply cold for a minimum of 10 minutes. Repeat as necessary.

Precautions:
Follow packaged instructions carefully. Ice can burn or damage skin and tissues if used improperly. Do not use Ice over areas of numbness or decreased sensation.  Most sources agree that alternating the use of heat and ice has not been shown to have any more benefit than applying ice or heat alone. The above information has been commonly reported by a variety of sources, although new research is constantly challenging previous information. Please remember that if you have any questions about using Heat or Ice, you should consult your licensed healthcare practitioner.

Founded in 2004, Elite Health Services, with locations in Old Greenwich and Westport, CT., is a world-class provider of certified functional manual physical therapy, personal fitness training and longevity related services. Over the past decade, our team of highly skilled and dedicated professionals has successfully helped thousands of elite athletes and active individuals in the tri-state area to eliminate pain and achieve outstanding results through exceptional care. To learn more about how we might help you too, please visit:www.EliteHealthServices.com

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