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

This article is the second part of a 2-part article that will focus when you should ice and when you should use heat on injuries or achy muscles. I will also give information on proper ways and techniques to apply ice and heat to injuries. Last week I discussed the dos and don’ts of ice applications, and this week it’s time to turn up the HEAT! But, before you reach for that heating pad, read this first!

If you haven’t already done so, you will want to scroll back to Part I of this article and read the information under the following headings:

Ice is for injuries, and heat is for muscles. Roughly.

When not to use Ice or heat?

What about injured muscles?

What about Headaches, Migraines and Arthritis?

The proper way to Ice an acute injury

I feel the same way about heat application as I do cold…the heat (or cold) device used must be able to maintain its heat or cold consistently. This is why I don’t like gel packs or bags of peas for cold application. The proper temperature at which to use heat may be relative from person to person, so I suggest you use a heat temperature that is about the same as the temperature at which you shower or bathe. The heat source should not have their heat source be hot to the point of burning the skin. The desired effect is for the heat to penetrate down into the muscles. Simply increasing the temperature of the skin will do little to decrease discomfort.

Time Required: 10-20 minutes

The duration that one needs to apply the heat, though, is based on the type of and/or magnitude of the injury. For very minor back tension, short amounts of heat therapy may be sufficient (such as 10 to 20 minutes). For more intense injuries, longer sessions of heat may be more beneficial (such as 30 minutes to 2 hours, or more).

If this is an at home heat therapy, (and indeed that is what I am writing about) I feel 20 minutes to be the top limit of time that you should use heat. Leaving heat on longer than 20 minutes can congest the muscle with blood, make muscles stiff and not achieve the desired results.

Types of Heat Therapy

Two options for heat therapy include moist heat and dry heat.

  • Dry heat, such as electric heating pads and saunas, draw out moisture from the body and may leave the skin dehydrated. However, some people feel that dry heat is the easiest to apply and feels the best.
  • Moist heat, such as hot baths, steamed towels or moist heating packs can aid in the heat’s penetration into the muscles, and some people feel that moist heat provides better pain relief. If I’m going to choose to use heat for a patient, I tend to choose moist heat.   The moisture allows the heat to penetrate more deeply into the muscles and ligaments rather than just affecting the surface tissues the way dry heat often does.
  • A specific type of heat therapy may feel better for one person than for another, and it may require some experimentation to figure out which one works best. There are many different manners for heat to be applied and some common options include:

Heat Option 1 – Hot water bottle

Hot water bottles are very inexpensive and can be purchased at any pharmacy. They tend to stay warm for about 20 to 30 minutes, so this makes them a good option. You will have to run your tap to about the temperature that you bathe and perhaps slightly hotter as the heat needs to penetrate the rubber bottle. To turn this into a moist heat application, simply run a wash cloth under hot water, wring it out thoroughly and apply the wet cloth directly to area you wish to heat, and apply the hot water bottle on top of it.

Heat Option 2 – Electric Heating Pad

Electric pads maintain a constant level of heat as long as it is plugged in and some even have timers so that you can program them to shut off in 20 minutes. To turn this into a moist heat application, simply run a wash cloth under hot water, wring it out thoroughly and apply the wet cloth directly to area you wish to heat. Then protect your heating pad by inserting it into a plastic bag and so that it does not come in contact with the moist towel, and apply the heating pad on top of the moist towel.

Heat Option 3 – Heated Gel Packs

These may be microwaved, or sometimes heated in water, and tend to say warm for about 20 minutes. Certain types of gel packs even provide moist heat. To turn these into a moist heat applications, simply run a wash cloth under hot water, wring it out thoroughly and apply the wet cloth directly to area you wish to heat, and apply the gel pack directly on top of it.

Heat Option 4 – Heat Wraps

Heat wraps are especially good if you are using heat while you are at work or doing something other than resting because they can be wrapped securely and can be worn directly against the skin and under clothing, providing convenience and several hours of a low level of heat application.

Heat Option 5-8 – Hot bath, hot tub, sauna, & steam baths

These tend to stimulate general feelings of comfort and relaxation that may help reduce muscle spasm and pain. A whirlpool jet directed at the injured area may provide the added benefit of a light massage. The other benefits of a bath or hot tub is that you can stretch the injured muscles while you are soaking. Often this improves the stretch and lessens the pain if it was initially painful to stretch.

When Heat Therapy Is Not an Option

Please note that heat should not be used in certain circumstances. For example, if the area or joint is swollen or bruised, heat should not be used. Patients should consult doctors if they have heart disease or hypertension. Heat application is not always suitable or recommended in the following cases:

  • Dermatitis
  • Deep vein thrombosis
  • Diabetes
  • Peripheral vascular disease
  • Open wound
  • Severe cognitive impairment

In general, if the injured area is swollen or bruised it is better to apply ice or a cold pack to reduce the swelling.

It’s typically a good thing to stretch heated muscles

Using heat can accelerate the warming up process for sports and help warm the muscles faster so that they are ready for static and ballistic stretching. But, remember, never stretch a COLD muscle!

In summary, heat therapy is an easy and inexpensive option to provide relief from many forms of muscle pain. It may be used alone or in conjunction with other therapies. Because it is so simple, it is often overlooked and physicians may forget to mention it, but heat therapy used in the right way can be a valuable part of many treatment programs.

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