The Great Debate: Heat vs Ice?


The Great Debate: Heat or Ice?
by Nathan Browne, DC
Published in Driver Health Magazine

It’s been a long day at work and all you’re looking for is some relief from the aches and pains of your daily routine. So what are your best options of relief…rest, stretching, ice, heat, all of the above?? Well if you said all of the above you’re close. All of the aforementioned therapies should carry some amount of relief if applied properly in the correct situation. Now the million-dollar question, what situation dictates the need for ice versus heat? The answer is less complicated than you’d think.

Traditionally ice is used for any injury that is recent or acute (within 24-48 hours). Ice works by narrowing the blood vessels in which it comes in contact with and thus limits the internal bleeding or swelling at the site of injury. When swelling is minimized the surrounding musculature and tissues can endure more movement and less functional loss. We all know that when we sprain an ankle it swells up to sometimes 2-3 times its normal size. Ice should immediately be applied in 10-15 minute increments to help reduce swelling, limit motion loss and minimize the initial pain. Ice is also good to help reduce minimal swelling as a result of exercise or physical exertion. For those of us who struggle with chronic conditions like osteoarthritis of the knee, icing the knees after a long walk, bike ride or swim can limit the amount of swelling caused by the micro-traumas endured with activity. Even the smallest bit of swelling can have an impact on your joints so be proactive and ice down after a workout, 10-15 minutes can make a big difference in recovery.

Heat, on the other hand, is used for more chronic or lingering injuries that are present for longer than a couple of days and not always associated directly with swelling. The opposite of ice, heat works by widening the blood vessels in an effort to promote more blood flow to the area, which will help relax the muscles or muscle spasms. It is recommended that heat be applied for only 15-20 minutes at a time and never while sleeping. For those of us who experience a lot of muscular stiffness in the morning when getting out of bed, heat can be a great natural solution. At night before bed apply heat to the area that tightens up the most while you are sleeping. A good 20 minutes of heat before bed can make a big difference the next morning and make A.M. stretching much more beneficial and enjoyable.

As you can see the decision between ice and heat isn’t strictly black and white as both can be used to provide relief for similar conditions. Knowing what circumstance to use them is the key. Swelling and stiffness often go together and it is always best to address the swelling first with ice. Once the redness and swelling has been reduced significantly heat can then be applied to aid in relief of the muscular stiffness that may follow. When in doubt, if you need pain relief from an acute condition roll with ice, if you need relief from prolonged muscular spasm and stiffness, heat is the answer. Hopefully this sheds some light on a topic that comes up a lot in practice, please remember ice and heat are just tools to use to assist in the healing process and should not be viewed as anything more.

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