Ever wonder whether you should ice or heat your injuries?  

In the scientific community, the answer to this is inconclusive mainly due to the lack of Randomised Controlled studies (the gold standard in scientific testing) that support either.  Some studies suggest that icing an injury may delay the healing process if applied incorrectly. However, many health and sports practitioners prescribe this method because icing is an easy, effective, natural and cost-effective way to relieve pain from acute (recent) or chronic (long-term) injuries.

Applying ice or heat is not a treatment for injuries, but rather, they are simply a means to relieve pain and reduce symptoms and should only be used in the appropriate circumstances. In addition, ice and heat therapy are only a small part of a proper recovery or rehabilitation program.

Ice (or Cryotherapy)

When to use it?

Ice is used to relieve pain caused by tissue damage or inflammation. Cool temperatures decrease blood flow to the injury site and reduces tissue metabolism, oxygen utilization and inflammation. The best sites to use ice is where superficial tissue injury is still fresh, when the area is red, swollen, hot, sensitive to touch or visibly bruised. Acute injuries fare best when iced immediately after the injury has occurred and within the first two to five days of injury.

Chronic injuries, like Achilles tendonitis or runner’s knee, and overuse injuries can benefit from ice to control or reduce inflammation after activity.

When not to use it?

Generally, muscle pain tends to respond unfavorably to ice and can sometimes aggravate the pain, as in low back muscle pain. Unless there is a structural problem, low back pain is rarely caused by inflammation, in which case, the layers of tissue in this area are so thick that icing would not reach these deeper layers. Instead, the ice will reach trigger points or sensitive knots that are more accessible at the superficial muscle layers, which may cause aggravation.

Other circumstances that may contraindicate icing include applying ice to areas that are already numb due to neurologic conditions, or if vascular disease and poor circulation exists, or if the individual is hypersensitive to cold temperatures.

How to apply ice and how frequently?

The raw form of ice, for example, an ice cube or water frozen in a styroform cup can be used to reduce inflammation. A styroform cup can be peeled away as the ice melts. As a precaution, ensure that you have ice in the freezer to allow for immediate use. The cold ice and melting water penetrates into the crevices of the skin, drawing heat from the skin and promoting decreased inflammation.

Frequency and duration varies among studies but a good rule of thumb is, “when you’re numb, you’re done”, in other words, ice the area using a slow, steady massaging motion for no longer than three minutes. Applying raw ice for any longer can potentially burn the area. You are done icing if, when applying pressure to the area, you are unable to feel your finger or you only feel pressure. Once finished icing, allow the skin to become warm again and only then, repeat the icing routine. Thicker areas like the thigh will need more time than thinner areas like the shin. This routine can be repeated frequently throughout the day, as long as you allow the skin to warm again before the next ice application.

Remember that icing requires a commitment of at least a week before you can say that it was or was not successful for you.

Heat (or Thermotherapy)

When to use it?

Heat is useful for most non-inflammatory body pain with muscle being potentially the most common source of pain.  It is most useful in cases of acute soreness, like after a run or gym workout, at the end of a long day in front of the computer or stiffness associated with conditions like osteo-arthritis.

When not to use it?

Heat is more aggravating to areas where inflammation exists, as in areas of fresh injuries or infections.  When skin is physically damaged, red, hot, swollen or sensitive to touch, err on the side of caution and do not apply heat.  Heat will encourage an inflammatory reaction that can aggravate the pain.

Other circumstances where using heat is contraindicated are before physical activity, if the area is numb due to neurological disorders and if body temperatures are elevated due to fever or heat stress.

How to apply heat and how frequently?

You can apply heat to a specific body parts (locally) or your whole body (systemically).  For local heating use hot water bottles or wheat bags that are microwaveable and for full body heating use saunas, hot baths/showers, steam rooms and for as long as you can manage the heat.  Applications of heat for 15-30 minutes is an acceptable amount of time.

I hope that this information has been helpful for you.  Please contact me if you have any questions or if you are interested in receiving a list of references used for this article.