You and Your Health - To ice or heat - That is the question!


By Dr. Mark Perrett

BSCs DC Chiropractor

There is a lot of confusion regarding whether to use heat or ice when you have pain.  Both therapies are inexpensive and effective when used properly.  This article will reveal when it is appropriate to use either option.

Ice therapy:

The effects of ice

A good  saying to remember is: “ice is for injury”. If you sprain an ankle, twist a knee, or acutely injure another area of the body, ice is your treatment choice.

Applying ice to an  injured area helps to manage swelling, decrease pain, and lower muscle spasticity. The largest physiological effect of ice is contraction of the surrounding blood vessels, called vasoconstriction.  When injured, the body often over-compensates and drives blood flow to the injured area to cause swelling. The reason for this is to ward off any potential pathogen in the area, and also to promote healing.  Ice is a great short-term way to calm down this over-reaction.

Ice therapy can also be applied to the entire body in the form of an ice bath or submersion. This technique is often used by athletes after rigorous exercise.  Some studies show that this technique allows the athlete to recover faster by helping to control joint swelling and muscle tightness.  One of the major effects of this technique is the release of endorphins, natural pain killers, for an extended period of time after the ice bath.

Ice should be applied as soon as possible after an injury and used for only 10 to 15 minute intervals per hour for the first 24 hours of the injury.

Common icing mistakes

1. Ice should never be placed directly on bare skin.  This leads to a risk of frostbite. 2. Do not leave the ice on for over 15 minutes, even though it numbs the pain. 3. Don’t apply ice to stiff and achy muscles, as it can cause spasm and pain. 4. You must rest and elevate when icing. The RICE rule is “rest, ice, compress, elevate.

Avoid using ice if you have hypersensitivity to cold, cold intolerance, peripheral vascular disease, cardiac disease, or over a re-generating nerve.

Heat therapy:

The effects of heat

A good saying to remember is: “heat for hurt”. If you have achy muscles, pain that has been present for over three days, or chronic pain, heat is the best option for you.

The physiological effect of heat is the opposite of ice. It causes dilation of the blood vessels, called vasodilation, and therefore promotes blood flow to the tissues. This benefits an injured area because increased blood flow carries healing agents and oxygen to the injured site, and carries away byproducts of the injury. Heat therapy works very well on muscles, as there is a large blood supply in these tissues.  Lactic acid is a common reason for muscle stiffness and can be decreased with the application of heat.  Heat should be applied for 20 to 30 minutes per hour at a moderate temperature.

Total body heat such as spas and saunas have similar effects to applying a heat pack.  Research also shows that by stimulating  the cardiovascular system, saunas can lower cardiovascular risks, improve brain health and increase lifespan.

Common heating mistakes

The biggest risk of using heat is getting burnt.

1. Never place heat directly on the skin, and make sure your heat pack is not too hot.

2. Always use a heating pad that has an automatic shut off.

3. Only use heat on an injury over three days old and never jump into a sauna or hot tub after vigorous exercise.

Avoid using heat on areas that are red, hot and swollen, such as an acute joint injury.  Heat should not be used on areas of inflammation or on open wounds.  Hot tubs and spas should be avoided if you have cardiovascular disease.

A general rule is “ice for injury and heat for hurt”.  Like every rule there can be exceptions.  Some research shows with chronic back pain, heat and ice therapy have the same ability to reduce pain depending on the user. Also, some people just respond better to heat or to cold.

Using heat or ice can be an inexpensive and effective way to treat pain.  There are many different products on the market that can be both frozen and heated. Remember to always wrap up the pack and then place it on the skin and follow the recommendations that are provided.

Activity Fact: We have proteins in our body that are activated by heat and by cold and we have an amazing ability to use these to adapt to different climates.