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Heat vs Ice: When To Use One Over The Other

This is a huge debate and a question we frequently get in the clinic. Usually the question is “Should I use Heat or Ice for my pain”.  There are positives and negatives to both. This blog will discuss when to use ice versus heat and talk about other options to help with pain and swelling. We will also discuss the appropriate amount of time to spend on both and how the two can be combined.
Ice: Most of us are going to grab an ice pack right after we experience an injury. Many of us know that ice is generally used right away to help with any inflammation. It does this by slowing down the blood flow and inflammation reducing swelling and pain.  Sometimes our patients believe this to be the be-all and end-all, however, what some don’t realize is that inflammation can be a good thing! More recently medical practitioners have been debating the benefits of ice.  You see our body goes through four phases of healing after injury. Inflammation is the second stage and an important one that allows repair cells to move to the area of the wound.  The question is should we really be slowing down this process.  It is still up for debate.  We tend to tell people that it will decrease your pain.  Use that decrease in pain to try to move the inflamed area in a pain free way that helps push out the inflammation.  The only time inflammation is a major problem is when it lasts too long: greater than 2 days. If you haven’t seen reductions in the swelling by this time you need to see someone about it quickly.  The next stage of healing will occur after this stage of inflammation and we want that to start as fast as possible. There are many different forms of ice including: ice packs, cooling sprays, ice massage, ice baths. All of these tend to work well. I find that ice massage works best at decreasing pain opposed to a typical ice pack. You fill up a dixie cup with water, freeze it and apply directly to skin in circular motion until melted. Ultimately the choice is up to you! 
Heat: A lot of our patients like to use heat because this tends to make the muscles feel better and looser. There are two different types of heat; moist and dry. Most of us tend to use dry heat with a heating pad. Moist heat refers to a hot bath or hot towel. Both of these work well but it depends on which you prefer and what works the best. Many people ask if heat is good for pain and if heat can make inflammation worse.  Heat works best after the inflammatory phase (do not use where you have swelling) to improve circulation and promote blood flow to calm down the muscle.  Heat can help with certain types of muscle pain and help the muscles relax.

  • What we have noticed is that typically ice is used on joints (due to swelling) and heat is used on muscles (to help increase flexibility).  However-while this does work for most people your body may respond differently.  This blog isn’t medical advice only our observations.

How Long Should You Leave Heat or Ice On?
You only need to use heat therapy for around 15-20 minutes for it to work, however, you can leave heating packs on for about 30 minutes or take a warm bath for 30 minutes. It is important to be cautious in not leaving anything on too long and not allow the heat to be too hot to prevent a burn. Ice left on too long can cause serious damage to the nerves and/or skin so don’t go longer than 20 minutes and except for the ice baths where you are constantly moving the ice don’t put the ice or cooling device directly on the skin and never allow a wet material between your cooling device and the skin.


Some Common Contraindications for Heat or Ice
(contact a medical professional for heat/cold advice whether you have contraindications or not)

Ice

  • Deep vein thrombosis
  • Near a chronic (long term) wound
  • Anywhere you have decreased sensation
  • Areas that have been affected by tuberculosis 

Heat

  • Deep vein thrombosis
  • Vascular disease
  • Over an open wound
  • Impairment with sensation 
  • Cognitive impairment

Both ice and heat work well and they can even be combined together. You take the limb that you are experiencing pain; example: if you have wrist pain you can transfer your wrist from being submerged in hot (not too hot, think very warm) water to cold water several times. Usually this works best switching every 3 minutes. This helps to cause dilation (opening) and constriction (closing) of the arteries and blood flow improve the circulation in the area.  This sensation may help to decrease your pain. 
While heat or ice may help with the immediate pain issues Physical Therapy is the preferred method for most pain/injuries in all but the most severe surgical cases and would include hands on manual techniques, dry needling (if needed and wanted), soft tissue work, joint mobility work, stretching, strengthening, and kinesiotaping. Getting relief won’t take long and many people leave feeling better the first day. Even if you didn’t leave feeling better the first day it would only take 1-2 more visits max to start noticing improvements. However, starting that first day you would feel better right away knowing what is wrong and having a plan to fix it. 
If you would like more information on how we might be able to help you get rid of your pain please click the button below to schedule a time we can talk.  If you know you are ready to get some help right away you can call us at 720-651-0674 or email at jamie@kinetikchaindenver.com.

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