So often I am asked is ice or heat better. There are various factors that go into determining which is better. One of the easiest guides to follow: if it a new injury or if there is pain – ICE. If it is an old injury and there is stiffness – HEAT.
After an injury there is usually swelling, pain, and inflammation to a localized area. Most pain after an injury is due to the swelling putting pressure on the soft tissues in the area. The faster the swelling goes away the faster you heal. Elevation and compression of the area also help in decreasing the swelling.
Ice is a great modality because it is a:
- Pain reliever
- Decreases swelling to the area
- Decreases inflammation
- Helps healing process
Typical progression of sensation after application is 1. Freezing, 2. Burning, 3. Aching, 4. Numbness.
I get asked often what type of ice or modality can I use and how long it needs to be on. A general rule is 15-20 minutes (this is typically how long it will take ice cubes to melt). There are different benefits and drawback to different types of icing. Here are a few guidelines. It is always recommended to put a layer (cloth) between you and the ice as there is a risk of burn to the skin.
- Ice bag
- Inexpensive
- Conforms to the body part
- Easily available
- 15-20 minutes
- Reusable ice pack
- Conforms to body part
- Reusable
- 15-20 minutes
- Chemical pack
- Portable without external cold source
- One time use
- Never place directly on skin as it can get colder than skin can handle
- Ice bath
- Water temp only needs to be 50-60 degrees F
- Good for larger body areas
- 7-15 minutes
- Used more for muscle recovery than injury care
Heat, however, is a great modality for joint aches and pain. Heat works by:
- Increasing tissue temperature
- Increasing blood flow to area
- Decreasing pain
- Decreasing muscle tone
- Decreasing muscle spams
- Good prior to exercise or therapy to loosen up muscles and joints
Applications:
- Moist heat pack
- Deeper heat
- Covers area
- 15 minutes
- Easier to position on joints
- Dry heating pads
- Plug in or microwavable
- Does not heat tissue as rapidly as moist heat
- Can be used for longer periods of time
- Be careful of skin burns
- Paraffin bath
- Water and mineral oil melted to liquid state
- Apply to irregularly shaped body areas (hands and feet)
- Can be expensive – need proper equipment
When in doubt apply ice, there is less risk of improper application of ice than with heat.
written by Dr. Lisa Falotico for 3RRC
