“Should I use heat or ice?”

This is a question that I hear from patients almost everyday in the clinic. And the answer is not as simple as you would think. It is not only based on what will help the most, but also what the patient prefers.

First, Let’s Look at Reasons to Use Heat…

Heat is known for relaxing muscles, easing tension, and decreasing joint stiffness and is generally preferred due to it’s relaxation capabilities (who wants to be cold anyway!?). Heat is great for muscle tightness and spasm.

When a muscle is tight or in spasm it stays partially or completely contracted causing several things to happen:

  • blood vessels are constricted by the surrounding muscle
  • increased amounts of metabolic waste are produced
  • due to the blood vessel constriction, the waste accumulates in the muscle tissue aggravating it- this is when you get a soft, doughy, and tender feeling
  • the surrounding muscles and tissues become “unhappy”

This is where heat comes into play…. Heat allows the muscle to relax enough for the blood vessels to dilate in order to flush out the metabolic waste. This brings pain relief and the start of healing.

However, heat can increase pain if it is applied for too long or if your injury is acute (first 48+ hours) because it increases inflammation. Heat should not be used with acute inflammation, in areas of infection, or in areas of decreased sensation. If you have any concerns with using heat please check with your doctor first.

If you have it available, moist heat is often the best option because it aids in the heat’s penetration of the muscle. You can now find moist heat packs for home that can be microwaved or plugged in.

Now for Reasons to Use Ice…

Ice is great for that immediate injury to help decrease pain and swelling! Remember when you sprained your ankle as a kid?

Ice is also great for arthritis (flared), headaches and immediate pain relief – whether it is acute or chronic pain. You’ve heard of athletes that take ice baths (I’m shivering just thinking about it!), well they do this to prevent inflammation and to ease their pain after a tough workout or competition.

Ice decreases inflammation by constricting blood vessels and is often used with elevation. You may be familiar with the acronym RICE (Rest, Ice, Compress, Elevate) often used immediately after an injury. Only apply ice in 10-15 minute increments as inflammation is a normal part of the healing process and shouldn’t be completely inhibited unless directed by a physician.

Ice should not be used in areas of decreased sensation, decreased circulation, if you have cold intolerance or any medical condition that may contraindicate the use of ice. If you have any concerns, please check with your doctor to find out if it is okay to ice.

So Here’s the General Breakdown for When to Use Heat vs. Ice:

  • ICE: inflammation, recent injury, headache, pain relief, arthritis (a flare with inflammation)
  • HEAT: tight or spasming muscle, chronic (nagging) injury, arthritis (stiffness, but no inflammation)

I often recommend that my patients use heat in the morning to loosen up their muscles and joints to prepare for the day and then use ice at night if/when the inflammation and pain has set in. Alternating the two can be a great solution for those that need the best of both worlds!

Heat and Ice should not be applied for longer than 20 mins at a time.

Image by © Slallison | Dreamstime.com

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