Should I Use Ice or Heat?
Heat and ice have been a staple in the rehabilitation of injuries. They prove to be a simple but effective treatment that patients have easy access to and rarely include negative side effects. It is important to know that neither heat nor ice have the ability to fix an injury or painful condition, but they still have a place in pain management and rehabilitation.
This article will address a few questions related to heat and ice being used in rehabilitation:
Does heat or ice fix injuries?
Will heat or ice help my pain?
When should I use heat?
When should I use ice?
What are some tips to use heat or ice safely?
We hope that our answers help you, a family member, or a friend better deal with an injury or condition.
Does Heat or Ice Fix Injuries?
Heat and ice have a limited ability to penetrate deep into the body. Superficial thermal modalities such as a heating pad or ice pack can only penetrate about 2 centimeters, or about .75 inches, deep. Body parts that have less muscle and fat may allow for a greater effect from heating or cooling (hands, feet, knees), but the blood coursing through your veins will hopefully normalize the area quickly since the body is pretty amazing at keeping its normal temperature.
Ice may have some benefit in slowing down the rate of swelling within minutes of an injury. Ice may have some ability to help reduce swelling, but is more effective at slowing the process from worsening as opposed to getting rid of swelling that is already present. There are other more effective modalities and techniques to improve healing and reduce pain compared to only applying ice to the affected area.
Heat or ice will not fix an injury, however, that doesn’t mean that these modalities can’t have a role in improving your situation. For the most part, heat and ice will feel good. Don’t count out the effect of something that feels nice. When you are in pain, something that feels nice may be enough to provide some relief or distraction and allow you to take the next steps in actually getting better.
Will Heat or Ice Help My Pain?
To understand where heat and ice play into your recovery, first we need to have a quick talk about pain. Pain is at least partially in the brain. That does not mean that it is “all in your head”, this just happens to be where pain is processed and recognized. Once you know that fact, you can learn how using treatments that feel good play into reducing pain. If pain is sensed in the brain, and the brain controls our reactions to pain, then something that feels good, like heat or ice, may contribute to feeling better and have a lesser pain response. This could be through a cold or numbing sensation, or through using heat for a more relaxing response. From my clinical experience, using heat is helpful especially when trying to reduce muscle tension or stress related pain. For a few other tips on stress related pain, read Stress, Pain, and Injury. Can Physical Therapy Help Me?
When Should I Use Heat?
The therapeutic effects of using superficial heat include:
decreasing muscle spasm and tone
increasing blood flow
increasing extensibility of connective tissues
increasing nerve conduction speed
Superficial heat can be helpful with muscle guarding and spasm, decreased range of motion, and subacute or chronic pain. If range of motion is restricted by tight muscles, heat may be an effective way to decrease muscle tone, especially if paired with stretching or massage. Heat typically has a relaxing effect. If this is the effect that you desire, heat may do the trick! If you layer this with other relaxation type techniques such as deep breathing, meditation, or a comfortable position, heat may be more effective. It should be avoided for acute injuries, peripheral vascular disease, and over areas of poor sensation in order to prevent adverse effects such as increased bleeding or burns. If using heat in isolation provides temporary relief but the pain returns, it is recommended that you get evaluated by a physical therapist or orthopedist to determine a proper diagnosis and plan.
When Should I Use Ice?
The therapeutic effects of using superficial cold therapy (which is also called cryotherapy) include decreasing blood flow, reducing edema, and decreasing nerve conduction speed. The best time to use ice is immediately after an injury or surgery.
Immediately after an injury, the body responds via inflammation. The main signs of inflammation are called the cardinal signs and include redness, swelling, heat, pain, and loss of function. Ice can be helpful for acute injuries and inflammatory conditions in order to control swelling, especially when paired with compression and/or elevation.
When using cryotherapy, there are four stages: cold, stinging, aching, and numbness. These stages can take anywhere from five to 15 minutes. It is recommended to use ice for at least 15 minutes in order to reach that numbing stage and ensure the targeted tissue has reached a temperature to provide its therapeutic benefit.
Ice has a pain relieving effect because it causes analgesia, also referred to as numbness. This is why ice can feel good even if it is no longer providing much anti-inflammatory benefit. It should be avoided over areas of poor sensation, regenerating nerves, or with cold intolerance such as Raynaud’s syndrome in order to prevent adverse effects such as cold burn.
What are Some Tips to Use Heat or Ice Safely?
There should always be a layer between the ice/heat pack and the skin, such as a towel or wrap. Keep in mind, a moist layer will conduct cold/heat more than a dry layer. It is important to check the skin after five minutes to ensure your skin is not reacting poorly to the heat or ice, if there is excessive redness, another layer should be added to control the temperature to tolerance. As previously mentioned, it will take around 15 minutes to achieve maximum temperature change with both heat and ice, so it is not necessary to leave it on for more than 15-20 minutes and will help reduce likelihood of burns.
It is important to consider positions of use as well, for example laying on a heating pad will increase the effect of the heat and may cause increased risk for burns. Please always make sure the area of skin being used has intact sensation, areas with decreased or impaired sensation will not be able to provide warning signals if the temperature is too high (or low) or if pressure is causing injury to the skin.
Using superficial thermal modalities will only provide temporary relief, therefore it is important to speak with a medical professional if pain is recurrent in order to ensure you are being treated as effectively and safely as possible.
If heat and/or ice is currently part of your injury or pain management strategy and progress is not where you would like it to be, request an appointment with one of our physical therapists. We can assess your situation and develop a comprehensive treatment plan to help you feel better and get you on track to better health.