Should you use Ice or Heat…that is the question? Part I

I’ve now been practicing for 24 years and one thing hasn’t changed…I still counsel my patients on whether to use ice or heat (and how to use them properly), yet I have never written an article or blog about it.  Well, here it is folks, the “how to’s” of ice and heat according to science and Dr. Hoch. Before you reach for that ice pack or heating pad, read this first!  This article is the first part of a 2-part article that will focus on proper ways to use ice on injuries. Next week I will discuss the proper ways to use heat to treat injuries.

Ice is for injuries, and heat is for muscles…mostly.

In this information age how is it that there is still so much confusion regarding icing vs heating — cryotherapy vs thermotherapy?   Both these therapies are rational, helpful, and inexpensive or free self-treatment options with minimal risks.

It’s been popular in the past few years to debunk well known, tried and true remedies of all kinds. Icing hasn’t been exempt from this topic, and while the backlash against icing has some merit, I feel in this case it’s mostly a non-issue. The majority of icing is done for minor pain control, and there’s really nothing wrong about that, in my opinion.

Ice is for injuries: to calm down damaged superficial tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process that occurs in response to irritation, injury and infection… it just also happens to be incredibly painful and sometimes more biologically stubborn than we’d like it to be. Using ice is a mild, drugless way of dulling the pain caused by inflammation and reducing the inflammation itself.

Use ice for new (acute or abrupt onset injuries) such as sprains (ligament or disc injuries), strains (muscle injuries), or broken bones (after they have been set/treated by your doctor).

Heat is for muscles, chronic pain, and stress to take the edge off the pain of whole muscle spasms and trigger points, or conditions that cause them, like back pain and neck pain. It is good for soothing the nervous system and therefore, chronically tight muscles, and the mind.

Use heat on chronic longer term injuries or sometimes sprains and strains that are, as a general rule, not more than 3 days old. Heat can also be beneficial for tension in muscles and the body after a stressful experience that causes tight muscles and pain.


When not to use Ice or heat?

Heat can make inflammation worse, and ice can make muscle tension and spasms worse, so they have the potential to do some mild harm when mixed up.

Both ice and heat are pointless or worse, perhaps harmful when used inappropriately. Icing when you’re already shivering, or heating when you’re already sweating are bad ideas, but heat and inflammation are a particularly bad combination.

If you add heat to a fresh injury, it’s going to get worse!

If you ice painful muscles, it might get worse! Ice can aggravate sensations of muscle pain and stiffness, which are often present in low back and neck pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain.

What about injured muscles?

If you’re supposed to ice injuries, but not muscle pain, what do you with injured muscles (a muscle tear or muscle strain)? That can be a tough call, but ice usually wins — but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury usually involves obvious trauma during intense effort, causing severe pain suddenly. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat. For those of you who think that you can “pull a muscle” without intense activity, you’re wrong. Muscles can become stiff and spasm is response to inactivity (such as when riding in a car for a long period of time or falling sleep in an awkward position, but these are not “muscle pulls” (aka muscle tears).


What about Headaches, Migraines and Arthritis?

In the cases of headaches, migraines and arthritis pain, use whatever feels best to you! Your own preference is the tie-breaker in these situations and probably the most important consideration. For instance, heat cannot help if you already feel unpleasantly flushed and don’t want to be heated. And ice is unlikely to be effective if you have a chill and hate the idea of being iced!

If you start to use one and you don’t like the feel of it … just switch to the other.


The proper way to Ice an acute injury:

Time Required: 20 minutes

Use the acronym CBAN to identify if you’re icing technique is working.

C: Initially the application of ice (no matter which method you choose), will cause your skin and tissues to feel Cold.

B: Within a few minutes, that cold sensation will change and it will begin to feel as though it is Burning.

A: Then it will start to Ache.

N: Lastly, at about the 15-20 minute mark, the iced area will feel Numb. This means you have completed the phases of icing and ice should be removed.

Ice Option 1 — Traditional:

Use a Ziploc bag with ice cubes or crushed ice. Add a little water to the ice bag so it will conform to your body. Wet a paper towel and lay it over the injured area, then apply the ice on top of the paper towel.

Ice Option 2 — Best:

Keep paper cups filled with water in your freezer. Peel the top of the cup away and massage the ice-cup over the injury in a circular pattern allowing the ice to melt away. Move the ice over the skin in a circular motion and keep it moving, so you don’t ice burn the skin.

Ice Option 3 — Gel packs:

Cold gel packs can be purchased at just about any pharmacy and provides a reusable treatment method, but gel packs aren’t as cold as direct ice or ice in a bag, and therefore won’t be as     effective. Don’t forget to use the wet paper towel against your skin.

Get the ice on quickly 

Icing is most effective in the immediate period following an injury. The effect of icing diminishes significantly after about 48 hours.

Don’t forget to elevate

Keep the injured body part elevated above the heart while icing — this will further help reduce swelling.

Watch the clock

Ice for 20 minutes, but never longer. You can cause further damage to the tissues, including frostbite, by icing for too long. Allow time between treatments by allowing area to warm for at least 45 minutes or an hour before beginning the icing routine again. You can repeat as desired or directed by your health care professional.

Prevent Frostbite

Do not allow ice to sit against the skin without a layer of protection. Either continually move the ice (see “ice massage”) or use a thin towel (a damp paper towel is perfect) between the ice and skin.

Do NOT stretch cold muscles

If you have been directed to ice and stretch muscles, never stretch a muscle that has just been iced. Only stretch warm muscles. This means you should a) stretch before you ice, or b) wait an hour or more after icing before you stretch, or c) heat the muscle a bit before you stretch it.

Tune in next week for: “Should you use Ice or heat…that is the question? Part II” for tips on how to therapeutically use heat to treat injuries, aches and pains.




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