Heat or Ice?

One of the most common questions I get asked often when a patient finishes their initial visit is if they should apply ice or heat to an injured area. The answer to this depends on both the patient’s condition and how long they have had it. In order to understand the when and/or the why either is applied, let’s take a simple look at the mechanism of each modality.

Ice is cold and, if you recall from your basic physics course, its natural action is to contract. When it is applied to the body, the surface blood vessels constrict along with blood circulation to the area decreasing. Due to lack of circulation, it will desensitize or ‘numb’ the area where certain sensations such as pain cannot be felt. Ice is commonly used as natural pain reliever and it is used within 2-3 days of the initial injury date. One of the most common misconceptions about ice is that it helps reduce swelling. While that is true if a large amount is applied, a simple ice pack cannot reduce swelling unless the area is compressed with a wrap or an ace bandage.

Heat does the opposite of ice. If ice contracts, heat would expand. Heat promotes blood circulation to the area, thus causing the muscles to relax. It also has a comforting sensation which allows the whole body to relax and can be considered as a relaxant. Recent research suggests that contrary to traditional beliefs, heat can also aid in reducing swelling of the body. Heat is used when the injury persists for more than 1 week.

As a simple reminder, ice is applied when an injury occurs immediately (acute) while heat is applied when that same injury lasts for more than a week. The rule of thumb is that either can be applied locally on the injured area for approximately 15 to 30 minutes, at least 2 to 3 times a day. I always tell people to apply either one when they are resting such as watching TV or reading a book.

These modalities are a great aid in any recovery process that produce positive effects. Either one of them is inexpensive and can be readily found in any drug stores or at home. For ice, a simple bag of ice cubes can be used but it is important to remember to put it in a plastic bag and have it wrapped with a moist towel to get the most ‘cooling’ effect. As for heat, I generally prefer patients to invest around $30 for a plug- in heating pad but other measures can be used as well. One of them would be to moisten a towel and microwave it to the desired heat setting. Please heat it to the point where you or the patient feels comfortable, as to we do not want to burn anyone!