When to use Ice vs. Heat

I often get asked when to use ice vs. heat for back and neck complaints or after an injury to a joint or muscle.  The answer depends on an number of factors, like is it a new injury?  Is there inflammation, arthritis or muscle stiffness?

WARNING:  Conditions that effect sensation like diabetes and neuropathy can make it harder for you to judge if ice or heat are causing damage.  Circulation issues can be aggravated by ice and/or heat.  In these cases seek the advice of a qualified professional before using ice or heat.

When to use Ice:

1. Acute injury is a recent slip, fall or lifting incident for example.  I covered this in some detail when talking about what exercise is good for back pain.  There is often signs of swelling around the joint or muscle and it can feel hot.  As a generalisation the pain you may experience is sharp/grabby/pinchy .  Ice can “numb” the painful area allowing you to cope better while recovering.  More movement will then be possible to avoid loss of mobility and strength.
2. Inflammatory conditions such as arthritis and bursitis can benefit when the inflammation is active.
3. After exercise or exertion when an older injury “flares up”.
4. After treatment.  A Chiropractic adjustment involves touching and moving vertebrae and joints that are stressed.  An ice-pack after your adjustment will sometimes be recommended for pain management and inflammation reduction to make sure you get the best out of your treatment.

When to use Heat:

1. Chronic Conditions.  Heat is preferred for long term muscle tension and  stiffness.  It can help relax muscles, increase blood flow and promote healing.
2. Muscle spasm.  Heat can help relax muscle spasms.  Caution: if the spasm is caused by a recent injury – any heat applied to that injury can aggravate swelling and delay healing.  When in doubt use ice!
3. Joint stiffness.  Arthritic joints that aren’t inflamed-i.e. more likely to have deep dull ache and are stiff without any pinchy/grabby pain, will benefit from heat.  Again, flexibility and circulation can be improved.

How to apply ice:

1. 1. DO NOT APPLY ICE DIRECTLY TO SKIN
   2. Best way is to use a frozen flexible gel ice pack.  If they are frozen solid, let thaw for a few minutes so ice-pack is flexible.
   3. “Esky bricks” are best avoided also
   4. Good alternatives are a handful of ice cubes in a plastic bag or a bag of frozen peas.
   5. Wrap ice pack in damp tea towel.
   6. Apply to the skin directly over area of concern.
   7. for an acute episode, 10 minutes per hour for the first 48-72 hours will be required.

How to apply heat:

1. Moist heat can be best to penetrate into the stiff muscles and joints.  There are some challenges to doing this however.  Standing under a hot shower for extended periods is not the most environmentally friendly way to do it.  Using face washers soaked in warm water is not very convenient as they cool down quickly.
2. Microwavable heat packs are convenient.  Wrap in a towel and test temperature thoroughly before applying to skin.  “Heat wheat bags” are also a popular method.  Be sure to follow manufacturer’s directions for heating either the gel type pack or the heat wheat bag.
3. Hot water bottles.  DO NOT USE BOILING WATER.  Warm water is enough and wrap in a towel to avoid scalding.
4. Apply up to 20 minutes at a time and be sure to monitor the temperature to avoid burns.