Ice Versus Heat for Pain Relief

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“I just pulled a muscle. Should I put ice or heat on it?”

“I have a muscle pull that has been lingering for months, should I use ice or heat?”

“I have a pain that has been chronic for years, should I use ice or heat?”

“I have joint pain that comes and goes. Should I use ice or heat?”

These are all questions that I hear frequently. If you use your body and exercise, you will get aches and pains and muscle pulls. Even if you don’t use your body and don’t exercise and are mostly sedentary, you will have more aches, pains and muscle pulls. So what is the best way to treat them?

Hands down, the best way to treat any of these injuries is with ice. Ice decreases inflammation. Ice causes the capillaries in the skin to reflexively contract, which causes vasodilation. When the ice is removed, the capillaries open up and flush the area with fresh blood that washes away inflammation and inflammatory waste products. This will help the injury heal quicker, and reduce the pain of the injury.

In my opinion, as long as there is inflammation, ice will work best. The reason why you take ibuprofen (or any other anti-inflammatory such as Aleve or aspirin) is to reduce inflammation. Ibuprofen also decreases the sensation of pain from being transmitted to your brain and making you become conscious of the pain. Ice will decrease pain by numbing the injured area.

Heat is effective for certain issues. If you have arthritis in your hands, heat can help them calm down. I also recommend using heat to warm up. I use heat on my patients prior to working on them to loosen up the muscles which allows me to get deeper into their muscles. If you wake up stiff and sore in the morning and have trouble moving, then a hot shower followed by stretching is a great way to loosen up tight and irritated joints. Just make sure to follow the stretching with ice on the irritated area. Otherwise you’ll end up creating more inflammation in the long run.

If you have a muscle pull, or have pulled your back, shoulder, neck, hip, etc, or have “thrown out” any of those areas, heat and bed rest is one of the worst treatments. Heat and bed rest will cause the injury to linger, if not get worse.

Heat will temporarily loosen up tight and irritated muscles. Heat will temporarily calm down irritated joints and muscles. Heat is very soothing. But heat will draw fluids to the area by causing vasodilation in the capillaries of the skin and can increase inflammation and cause swelling. Heat will cause an issue to linger, if not get worse. If you throw out your low back (which is usually do to a muscle pull/ sprain/ strain), you will encounter someone in the health care profession that will recommend heat for it.

Bed rest will cause the muscles to atrophy and can actually cause you to age prematurely. Bed rest will also cause the muscle pull to get worse. In order for a muscle pull (or sprain or strain) to heal, the muscle has to move around. I use the analogy that when injured you don’t want to run a marathon, but you don’t want to still or sedentary or sit for longer than 30 minutes. The longer a muscle is inactive, the tighter it will become. This will keep the muscle tight and irritated and not allow it to heal. A chronically irritated muscle will cause imbalance throughout the body and affect many other areas. This is why when someone injured themselves, there can be a domino effect, meaning that one injured area will cause other areas to become injured over time.

Many health care professionals will recommend using ice during the first 24 hours (the acute phase) and then heat afterwards (when it becomes chronic). An injury can stay acute for weeks. In order for an injury to become chronic, it has to be present for over 4 to 6 months. Once an injury is present for that long, it will get neurologically wired into your body and then become chronic and long-standing. An injury doesn’t just magically become chronic after 24 hours.

As long as there is inflammation and pain, I believe you should ice. Ice will help to decrease inflammation which helps to reduce pain. Ice will also numb an area and that will also help to temporarily reduce pain.

I recommend patients use ice for injuries that have been around for years — and they get relief from it. I recommend patients ice for joint and muscle pain that is associated with osteo-arthritis. An arthritic joint will irritate the surrounding musculature because the joint is moving differently than how it was designed. All the surrounding muscles have to compensate for the altered motion of that degenerating (arthritic) joint. Once this happens, then the muscles become part of the problem. From this compensation for altered motion, the muscles will slowly become tight and irritated over time. The muscles will eventually tear (become sprained) due to the increasing tightness, and then fall into a pattern of spasm and inflammation. As long as there is inflammation present, then ice will help. As long as a muscle is involved in an injury (and they usually are) then ice will help heal the problem.

This is why many professional (and amateur) athletes are turning to cold showers and ice baths after exercising. When you exercise, you tear muscle fibers on a microscopic level. This is why you get sore after a good workout. This tearing produces inflammation. If you take a cold shower (or an ice bath) after exercising, it will decrease the inflammation that was produced during the workout and help you to recover quickly from the workout.

For most of us, I recommend starting a shower on hot, then turning it onto cold for the last few minutes. Let the cold water run all over your body. This will decrease inflammation and help you feel better and recover from your workout without being sore later on. I worked on an offensive lineman for the Steelers who I got into taking ice baths. He now owns a professional grade ice maker and takes 40 minute ice baths to recover from his workouts. Granted, he is going to have more padding and insulation on his frame then we do, so he can handle that kind of cold. Most of us cannot handle that kind of cold. And most of us are not putting our bodies through the pounding that a professional football player takes. That’s why I feel that having the last few minutes of a shower cold, is sufficient for reducing inflammation and facilitating recovery.

Use ice and cold to help you recover and to feel better. Use ice to reduce inflammation and pain. Use heat to get a stiff and irritated joint moving. Use ice and heat intelligently to facilitate recovery. It is the Pain Free Way.

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