Ice or Heat?
by Dr. Brian S. Seaman, DC, FRCCSS(C), FICC

I get asked this every day –

“Doc – should I use ice or heat?”

Generally, in the vast majority of cases, ice is the best.  It helps to:

  • Relieve pain and discomfort.
  • Relieve swelling.
  • Reduce inflammation of the nerves and soft tissues (ligaments, tendons and muscles) in the area.

Why Ice?

Following an injury, inflammation develops which causes swelling, redness and pain, as blood and tissue fluids begin the process of healing.  Your body may over-react however, allowing too much fluid and blood to collect in the injured area.  The result is that it takes longer to heal and longer for you to return to full activity.  The first goal of treatment is to minimize swelling and prevent further trauma to the injured area.  Once swelling is controlled, your health care professional can concentrate on returning the injured area to its normal function.

What is the best way?

You can apply a commercial ice gel pack, directly to the injured area.  Use a tea towel or paper towel between the ice pack and your skin.

You can also wrap crushed ice in a towel (to prevent frostbite) and apply directly to the injury for 15-20 minutes, every 2 hours.

A bag of frozen peas or corn wrapped in a towel also makes an excellent ice pack. 

You can also create a ‘ice towel’.  Take a towel and soak it in cold water and squeeze it until it is just damp.  Fold up the towel and place it inside a plastic bag or large Ziploc bag and put it in the freezer for 15-20 minutes.

You can also make an re-useable ice pack by mixing water and rubbing alcohol in a hot water bottle.  The mixture is generally 50% of each.  Place it in the freezer and the fluid will not freeze (will remain liquid or like a slush).

Important to remember

It is always important to remember never to place the ice or ice pack directly against your skin.  You should always put a thin cloth (like a tea towel) or a layer of paper towel between the ice pack and your skin to prevent “frostbite”.  Overusing ice is not good – too much of a good thing!  Using the ice for too long, can create a reaction of the body in which it shunts blood back into the injured area and therefore you lose the benefit of having used the ice.  It can also damage your skin and you are left with a dry and/or brown area of the skin.  Generally, this will resolve over a period of time.

Why not heat?

Never apply heat to an acute soft tissue injury such as a sprained ligament, strained muscle or tendon, or a disc injury. That means no hot baths, whirlpools, heating pads or heat-producing creams or lotions following these types of injuries. Heat is soothing and may make you feel better temporarily but it also increases blood flow to the area which in turn increases local inflammation and swelling. In turn this can increase your healing time.

What does research say?

There have been a number of research studies over the years dealing with ice therapy.  Years ago in North America, the way of dealing with arthritis was generally considered to be rest and heat.  However, it is now generally accepted that exercise (selected based on the patient’s condition) and ice works much better.

There was research done in Japan back in the 1980’s, which focused on a “cryo-exercise therapy program” developed by Dr. Toshima Yamauchi. This involved the treatment of significant osteoarthritic changes of the hip joint using ice therapy and extended periods of exercise. This demonstrated a significant improvement in the patient’s condition and according to an abstract of his research (presented in the European Society of Osteoarthrology, University of Kuopio, Finland, 1986) that “Long term follow-up has revealed continued improvement on maintenance of condition at time of discharge”.

As well, heat and ice have been used to compare recovery times for ankle sprains.  Generally, applying ice early after an ankle sprain reduces the recovery time by 2-3x.

Exceptions to the rule

Clinically, there are some times in which ice will not come or should not be used.  Patients who have experienced a significant bout of hypothermia (ie. lost in cold weather or have fallen into a lake or river) generally will not tolerate ice packs.

As well, there are is a small percentage of patients who find that ice simply causes the area to tighten up.  If you are dealing with an acute episode of lower back pain with associated muscle spasms, then obviously applying ice in that situation for that particular patient, would be counterproductive.

If in doubt…

Always try ice first.  If ice is going to aggravate the situation, the patient generally notices an increase of pain or discomfort (aside from the aching associated with an ice pack) within a very short period of time.  However, if using heat the adverse effects may not be evident for some time after using the heat pack.  During that time the body will tend to shunt blood into the area and to aggravate your condition.

Check with your health care practitioner

If you have an injury which is not responding to ice, after the first 24-48 hours, or it is causing a significant degree of pain or limitation in your daily activities, contact your health care practitioner for an examination and assessment of your injury.  Don’t fall victim to the “Oh it will get better” or “I thought it would go away”.

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