Ice VS heat for treating injuries

It’s been a while since my last blog so I thought it would be good to answer a question I get asked many times a week. Which is more effective, heat or ice and when should you use them? 
There is an enormous amount of confusion about the use of heat or ice in different kinds of pain. The confusion is made worse by all of the marketing guff on the brightly coloured packets at the local pharmacy. It is a shame it has been made so complicated. It’s really quite simple for most people in most situations.
Therapeutic heat and ice are simple, inexpensive and helpful self treatment aids for most people and can help with many common problems. Neither is a magic bullet, but they can help.

So which one to use and which injuries are they most suitable for?
 
Firstly to clarify when I’m talking about heat, I mean stick on heat patches (the sort that stick to your CLOTHES – not the ones that stick to your skin). When I’m talking about ice, I mean frozen water (cubes, frozen plastic bottle full of water). The little freezer gel packs don’t get nearly cold enough to have the effects we are looking for. 


Ice is for acute/new injuries near the surface

When you have a sudden onset of new pain and it is red, hot and swollen then ice is appropriate. Examples of when icing is good are a freshly pulled muscle or a sprained ankle. You can also use ice on chronic overuse injuries such as tennis elbow, plantar fasciitis and achilles tendonitis.
The inflammation that occurs with injuries such as these is a healthy and normal process, but it’s painful. Icing doesn’t help so much with the inflammation – there is some evidence it may not even directly impact recovery at all – but it is a great help for slowing down the particular process that causes pain. Wrap the ice in something (a thin cloth or tea towel), apply the ice until the area feels numb (roughly 5 minutes), then take it off. Wait till the area warms up again (again usually about 5 minutes)– and repeat. A lot.
 

Heat is for muscle pain/aching and stiffness, chronic kinds of pain, and stress related pain.

Heat can really help soften and take the edge off chronic pain. Chronic kinds of pain (pain that has been persisting for a long time and often returns) can involve a lot of anxiety and ‘sensitised nerves’ which create pain where there may be no longer a problem in the tissues. Warmth can really help with this, physically and mentally.
Over 99% of the time, my patients are advised to use heat for their back and neck pain because most of the causes of pain in the neck and back are not caused by things which are helped by ice (namely an acute injury). What often feels like an ‘injured’ back is usually not ‘injured’ but sensitised, especially if it’s been going on for a long time.

 
Contrast bathing is for tendon and repetitive strain injuries.

Contrast bathing (alternating cold and heat) can be useful for stubborn pain issues such as repetitive strain and tendons injuries like plantar fasciitis and tennis elbow. Start with cold and alternate every two minutes. It is a bit more of a faff to organise but alternating between the two can really enhance the therapeutic effects of ice. 

Now, just to really confuse you– The evidence also shows that in many cases, if a patient uses what they have a strong preference for it will work better for them than the alternative. So if you hate the idea of applying heat to yourself  – then try ice and vice versa. You can always change your mind if it makes your pain worse.

Heat and ice is only really suitable for injuries that are near the surface as once you get 4cm deep to the tissues there is very little temperature change so almost no therapeutic effect. If you are unsure whether to use heat or ice for your particular issue just call the clinic and we will advise you of the best way to proceed. 

Thank you for reading

Oliver

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