To Heat or to Ice- That is the Question

Hello everyone! Welcome to my first informative post! I plan on doing these more regularly on a variety of topics!

One very common question I am asked is whether heat or ice should be applied to an injury or site of pain. All-in-all IT DEPENDS on many factors. But I will try to break it down here- just know that there is a lot of gray area and I’ve never met anyone who did more damage by picking one over the other. As always- what I have written below is generalized and is not meant to replace advice given to you by your medical providers. Please comment or contact me if you have any questions or comments.

HEAT

When to use it

Most of the time, heat works really well on tight muscles. If you have neck pain, back pain, or muscle spasms heat tends to improve these symptoms by opening up blood vessels and bringing blood to the area. Blood has healing properties and can also loosen up tightness. Any time you feel stiffness or tightness, it is a good idea to try using heat. Other times heat works really well is prior to activity! Let’s say you have some back pain but you are planning on doing a workout- sometimes applying heat for about 15-20 minutes to the area of pain/tightness is a good way to warm it up before starting the workout. That way you’re not entering the workout cold and at risk for increasing the pain.

Disclaimer- this is not a solution to pain and I suggest speaking with a medical professional before exercising with pain. Please reach out to me with any questions.

When NOT to use it

If you have recently injured yourself that resulted in swelling or bruising in an area, heat is NOT recommended. The reason for this is with heat, you are bringing blood to the area which can actually cause more swelling. A good rule of thumb is to wait until there is no swelling or about 4-6 weeks after injury occurs. If heat isn’t helping your pain, then I would suggest not using it. If you have any of the following please speak to your medical provider before applying heat as it may cause complications: cardiac conditions, existing edema, area of injection sites, over metal implants, in an area of cancer, pregnancy, or if you have any bleeding disorders.

How to use it

There are many different ways heat can be utilized for pain relief. One of the most common uses from day to day is an electric hot pack. Other variations include hot tub, warm water immersion, sauna, microwaveable hot pack, etc. For all of these- you want a temperature that is COMFORTABLE. You don’t want to be giving yourself first degree burns. If you cannot tolerate the heat for 10 minutes then it is probably too hot. You also don’t want to have it so hot that your skin becomes very red and sensitive, although some pink/redness may occur depending on how sensitive your skin is. With any hot pack, I usually recommend no more than 20 minutes every hour for pain relief. Although most individuals do not use it that often. Use heat as needed, as you would pain medication, to alleviate any symptoms of pain, tightness, or muscle spasm you may have. It is not uncommon for people to have tightness or pain first thing in the morning. If that pertains to you then the morning would be a good time to heat (sometimes a hot shower is enough) so you can go about your day with greater ease. I find it helps my patients sleep better if they use heat right before bed- since heat can help pain and be relaxing it makes falling asleep a little easier. If you notice any skin irritation, you may have to evaluate how long you are applying the heat for, how often you are applying heat, and hot warm your heat source is.

COLD

When to use it

Cold- also called cryotherapy- can be used for decreasing pain and swelling. Cold will numb an area when applied for a long period of time which helps with pain, although may be short lasting. If an injury is new and there is visible bruising or swelling, cold would be the better tool to use. When cold is applied, the blood vessels in this area shrink (or constrict) and can improve the swelling. Cold can also be used for recovery after a hard workout to help decrease or prevent delayed onset soreness which usually appears 12-24 hours after a workout.

When NOT to use it

Cold can be used for a variety of reasons, however there are a few circumstances in which you should not use it. First and foremost, do not use prior to exercise. When cold is applied to an area, there can be a resulting effect of muscle stiffness. It is not a good idea to apply cold right before exercise because you will be at greater risk for injury if the muscles are stiff. If you are someone who has a blood vessel or circulation problem, cold should not be used as this could cause actual tissue death due to the lack of blood flow. Cold should not be applied to open wounds, on an area that has been affected by frost bite, or an area that is numb. Other considerations to keep in mind are individuals with a cold allergy or with a diagnosis of Raynauds Phenomenon. If you have any questions on whether cold application should be used for you- ask your doctor.

How to use it

The length of time you will administer cold for will depend on the type of cold you are applying. If you are putting an ice cube onto your skin, I suggest no longer than 5 minutes or when your skin becomes numb. If you are going to use a gel cold pack or a bag of ice with a towel between the bag and your skin, 10-20 minutes is usually appropriate. However if you skin goes numb before the time is up, remove the cold. There is always a possibility you can give yourself frostbite if cold is applied for too long.

Hope this post was informative for you all! I plan on posting similar informational topics more regularly on a variety of topics, all relating to physical therapy, injuries, prevention, disease, nutrition, and exercising. Comment below or contact me if you have suggestions!

Katie PT, DPT

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