What should I use to help my pain, heat or ice? This is a question that seems to get raised often in clinic and just as often gets confused. While there are some complexities around this, ultimately it can be quite simple, in theory anyway. Basically, If the problem predominantly involves inflammation, then Ice/cold is the treatment. If it is due to muscle tension, then we use heat. To classify what thing’s fall into what category we look in a bit more detail at specific problems.
All acute injuries fall into this category, such as sprained ankles, heavy knocks and falls, even broken bones and burns. When we use the term acute, it also implies that the injury has recently occurred, not a week or more later. Ice or cold therapy should be applied for a maximum of 10 minutes every hour for at least 24 hours after the injury. Applying the ice/cold for longer than 10 minutes at a time only results in the body heating the area up as a protective mechanism, which becomes counterproductive. Ice should not be placed directly onto the surface of the skin as this will burn and damage the skin. Use a barrier, such as a flannel tea towel or tee shirt. With burns, running cold water over the burn is more effective than applying ice.
Tight muscles and muscle spasms tend to love heat applications. Wet heat is the best. Hot baths, showers or even hot mud packs are ideal. Drier heat applications are typically less effective but can be better than nothing. Hot water bottles tend to be better than wheat bags. The length of application is longer for heat than ice therapy. Usually, 20 minutes is good but obviously not possible in the shower. The caveat with heat application is that some conditions have an overlap. In other words, there can be muscle tension and inflammation. This can create a bit of a dilemma as to which is the best. My advice here is to gauge how much inflammation is present. When a painful area is swollen, red and warmer to touch then we assume the inflammation is a dominant feature and probably would be made worse with heat application. If the inflammation is less obvious then you can try heat application. If the pain is worse with the heat, then remove it as soon as possible and continue with 10 minutes of ice.
Some chronic conditions (longer term problems) also fall into the overlap category, such as arthritis. The name “arthritis” suggests inflammation (‘itis’ is the part of the word in Latin that means inflammation). Nevertheless, arthritis may actually have little or no inflammation present at times. The pain in these cases may be from muscle tension. When this is the case, the pain may be reduced with heat applications.
I hope that makes it clearer and helps manage those aches, pains and injuries.