Ice Vs. Heat

One of the most popular questions I get asked by patients during practice is, 'how do I know when to ice and when to heat?' This can be a very confusing issue for people and is very important to address as it can affect healing times. If applied at the right time, recovery times will be decreased. The problem is that the answer is not 100% cut and dry and can vary between individuals, however there are some general guidelines to follow.

You always want to apply ice within the first 48 hours following an injury. This time is crucial to control and decrease inflammation. As soon as there is an injury, the body begins the inflammatory process as an attempt to begin healing. Ice vasoconstricts/closes the small blood vessels, decreasing the amount of swelling. Ice also helps to decrease sensation through the nerves, decreasing pain felt. There is a great acronym to follow when icing: C-BAN - cold, burning, aching, numb. You want to make it through and experience all four stages in order, then leave the ice source on for another few minutes once you reach the numb stage. This whole process should take less than 20 minutes. If not, be aware of the time and don't leave the ice on for longer than 25 minutes. You want to repeat this as frequently as possible throughout the first 48 hours, resting at least 30-60 minutes between ice sessions so the skin can recover fully before the next application. Rest, compression and elevation go along with icing to speed up healing. The RICE method: rest, ice, compress, elevate; all of these help to minimize the inflammatory process.

Heat is typically applied to muscle spasms and soreness to help loosen and relax the muscles. Heat vasodilates/opens the small blood vessels which allows new, fresh blood to flow through, improving circulation. (This is the opposite effect of ice and will actually promote inflammation). Moist heat is far superior to dry heat. Dry heat is a simple heating pad or sauna whereas moist heat includes hot showers, whirlpools, gel packs that can be heated up, etc. Moist heat penetrates deeper than dry heat; dry heat just heats the surface of the tissue, not really reaching down to those sore and spasmed muscles. If all you have is a traditional heating pad, you can moisten a towel so that it is slightly damp and layer between your skin and the heating pad.