“Should I use Heat or Ice?”

A very common question I hear from patients and people around the community is: “Should I use Heat or Ice?” The best way to answer that is to give it the perspective as a first aid tool and also by explaining the physiology of inflammation.

First Aid makes us typically think of bandages and pain medication but there is one First Aid tip that comes up so often that its worth repeating. “USE ICE” and if you are in doubt of whether to use ice or heat remember the First Aid rule… USE ICE!

Why? Because pain commonly comes from local swelling/ pressure and inflammation. Adding heat increases both, but ice reduces both. Yes, its really that simple. Normally its best to apply ice 20 minutes over joints that don’t have layers of muscles over them, like the hands, feet, elbows or knees and to apply ice for 30 minutes over areas that do have muscles on top like the neck or back.

Heat on the other hand comes in handy for muscle problems and almost strictly for muscle related issues; as long as those muscle aren’t near a joint filled with synovial fluid that could swell up and add to the pain in the area. Heat increases circulation of the capillaries and thereby increases blood flowing to the area. The heat feels soothing because the heat sensitive nerves are triggered, competing with the pain sensitive nerves, producing a “relative relief” by preoccupying the brain with nerve signals other than pain. Heat also increases local swelling that adds to the heat so once the soothing feeling is gone, the pain can be worst than before due to the increased pain due to the increased swelling. That is why we avoid heat where fluids can accumulate and cause swelling. Heat is best limited to 10 minute applications and low or warm heat can be extended to 20-30 minutes but not longer. Inflammation is how the body responds to inury, small or great.

Inflammation is marked by “redness, warmth and swelling” as its classical signs. Breaking these three aspects down we see redness and warmth because of the increased capillary circulation activity to bring the injured tissue nutrients for repair. Problem is this also increases the local swelling as liquids are pushed into the intra-cellualar areas due to the increased circulation. Swelling can increase to the point where it adds to the pain. Take for example a finger joint that swells and becomes painful; its really the swelling that causes most of the pain.

Thinking through what we just learned it becomes obvious that adding heat tends to complicate the healing since Mother nature already has the situation in hand. Another aspect of heat is the excessive use of heat. Necrosis is the destruction of cells and excessive heat can soften the tissues and actually damage the tissues setting them up for necrosis. That is why the First Aid Rule says: “if in doubt of whether to use heat or ice… use ICE!”

Yours in Health,
docMIKE