Heat and cold therapies are inexpensive, effective and generaly safe remedies for many different types of injuries and conditions. But there is a lot of confusion about whether to apply ice or heat to an injury or painful area.
While both, heat and cold therapies can reduce pain, inflammation, and swelling, they aren’t appropriate for every injury. Choosing the wrong one can possibly make your injury worse, instead of better. Knowing how to use ice or heat as your pain reliever can go a long way, whether you’re dealing with an injury that just happened or an ongoing nagging pain.
COLD THERAPY
What does it do?
Cold therapy, also called cryotherapy, reduces blood flow to an injury site. Well, by reducing blood flow, cold therapy also reduces inflammation, swelling and tissue damage. Also cold therapy has a numbing effect, which can help to decrease the pain.
When to use it?
Ice is used for acute pain, inflammation (swelling), and new injuries. Ice therapy is typically only beneficial for the first 48-72 hours; after that you want to allow blood flow to promote the body’s natural healing process.
So ice should be used right after an injury (sudden acute injuries such as sprained ankles, muscle strains or tears, bruising, bumps) or after activity that aggravates a chronic overuse or tissue fatigue injuries (plantar fasciitis, carpal tunnel syndrome, tennis elbow, shin splints).
How to use it?
Cold therapy works best and is safest when used several times a day (as much as every 2 hours) for short periods: 5 to 10 minutes and no more than 20 minutes at a time.
The protocol of applying ice for 10 minutes, then removing for 10 minutes, then reapplied for 10 minutes proved more effective than one 20 minutes application in pain management. The 10 minute protocol is most effective when repeated every 2 hours.
Homemade Ice Packs: ice cubes in a sealed baggie; a wet towel placed in the freezer for 15 minutes; a bag of frozen vegetables.
Safety tips:
- To avoid possible skin and tissue damage, never apply cold directly to the skin; wrap the ice or gel pack in a thin towel
- If skin is broken, make sure the wound has been cleaned and dressed before applying ice to avoid possible infection
- During, treatment, check skin every 5 minutes to make sure there is no damage. Immediately remove the cold source if the skin becomes very numb, blotchy, bright red, or blistered.
- Ice packs should not be used before exercise. It will mask pain, causing you to end up with more damage. Cold reduce muscular power and functional performance that can increase risk of injury
HEAT THERAPY
What does it do?
Heat therapy (which actually should just be warm, not overly hot), also called thermotherapy, is primarily for relaxation, comfort, reassurance and taking the edge off of the body pain.
Heat helps to open blood vessels and promote blood flow. This process increases the flow of oxygen and nutrients to the muscles, helping to heal the damaged tissue. Also it helps to ease soreness and stiffness, and relax tired muscles.
When to use it?
Use heat for ongoing/chronic-type pain, non-inflammatory pain or stiffness, such as from osteoarthritis (but not during flare-ups), muscle “knots” or trigger points, most kinds of cramping/spasm, acute soreness after activities or exercises.
Notable exception: heat works wonders for the acute muscle soreness that you get from overexertion, such as when you’re in pain from lifting heavy boxes or trying a new workout.
Heat can also be used before exercise to improve mobility and increase joint elasticity by essentially starting the warming up process before the exercise begins.
Also use heat for injuries past the acute stage, after 72 hours, or after the swelling has gone down.
How to use it?
Effective heating protocol includes heat packs or water submersion of between 40-45°C for between 10-20 minutes at a time.
Heat applied directly to a local area, like with heating packs, should not be used for more than 20 minutes at a time. Wait 1 hour between heat treatments.
Safety tips:
- Heat source should be warm, not hot, to avoid burns.
- Do not apply heat directly to the skin, use a thin towel.
- Do not use heat on bruises, swollen areas, fresh injury or open wounds. This can cause an increase of blood flow to the injury and create more inflammation.
- Do not use heat during an acute inflammation, like a flare-up of arthritis.
- Do not lie on a hot pack to avoid falling asleep and potentially burning yourself.
- Do not use heat if you have no feeling in the affected body part
- Do not use heat if you have poor circulation, such as if you have diabetes or deep vein thrombosis
Research shows that for many people, heat and cold therapies work best when combined with other treatment modalities, such as physical therapy (physiotherapy or osteopathy) and exercise.
| Arthritis | MOIST HEAT – Relaxes stiff joints and tight muscles |
| Gout flare-ups | ICE – Calms flare-ups and numbs pain |
| Headaches | ICE – Numbs throbbing pain
HEAT – Relaxes neck muscle spasms |
| Strains (muscle injury) | ICE – Eases inflammation/numbs pain – good to use in acute period
HEAT – Eases stiffness – better to use after acute injury phase is over to decrease bleeding into the muscle |
| Sprains (ligamentous injury) | ICE – Eases inflammation/numbs pain – good to use in acute period
HEAT – Eases stiffness – better to use after acute injury phase is over to decrease bleeding into the muscle |
| Tendonitis (acute inflammation) | ICE – Eases inflammation/numbs pain |
| Tendonosis (chronic injury) | HEAT – Relieves stiffness after inflammation resolves |