Heat or Ice?

This is often times the first conversation you may have with your health care provider after an injury or when dealing with aches and pains. “Which should I use at home? Is one better than the other? What are the benefits of one vs. the other and how do I use them effectively?”. Pain control can be the first step when starting physical therapy and heat and/or ice is usually the place people start.

Cryotherapy (therapeutic use of cold) has an immediate physiological effect on the body when applied. Cryotherapy is primarily used to control inflammation immediately after an injury, also known as the “acute” stage of healing. Cold applied to the skin causes immediate constriction of blood vessels and decreases blood flow to the area of application. The cold also thickens the blood, which decreases the “rush” of blood to the injured area. Blood flow to an injured area is important and healthy, but too much blood flow can cause excessive swelling. The acute inflammatory phase of healing usually subsides after 48-72 hours. A good way to check whether your injury is in this acute inflammatory stage is to feel the injured area. Is the area warm to the touch? Does the area feel “puffy” or swollen? If so, apply the RICE principal: rest, ice, compression and elevation. The sooner the ice is applied, the more beneficial it will be in reducing inflammation.

Another way cryotherapy can be beneficial is by “tricking” the brain into feeling less pain. When cold is applied, it slows down the conduction of pain fibers to and from the brain and injured area. This can be an effective way to provide temporary pain relief from various aches and pains. Lastly, cryotherapy is great at lessening or even preventing delayed onset muscle soreness (DOMS). DOMS occurs after a workout, where the muscles have undergone breakdown, inflammation and rebuilding. Typically, this soreness lasts for 1-2 days after your workout. Use gentle stretching and ice application to the sore muscles after your gym session, your body will thank you later.

Heat can also be used to manage pain, soreness, and muscle and/or joint stiffness. Heat dilates blood vessels and increases blood flow in the area of application. This increased blood flow, supplies fresh oxygen to the muscles and can help with healing. Heat is effective when used on tight muscles or muscles in “spasm”. Heat, just like cold, can alter nerve conduction which allows muscles to relax and become more flexible. Shoot for 10-15-minute applications of heat, along with stretching to allow for increased range of motion and flexibility.

To review, cold is best used for an acute injury within 48-72 hours to control inflammation and to increase pain threshold by altering nervous system function. Cold is also very effective in preventing DOMS after hard workouts. Heat is best used to increase muscle tissue extensibility (pliability or flexibility) or in treating muscle spasms, especially when combined with stretching.

If you ever have any questions regarding use of these modalities or how to manage your aches and pains, contact your local physical therapist and they will be more than happy to help!

– Travis Jurgens PT, DPT