Wednesday, September 21, 2011

Ice or Heat? Which is Better?

I get a lot of questions as a chiropractor about what to do when you get hurt, what exercises to do, what's the best posture, etc.  Probably one of the most frequent questions that I get is whether to put heat or ice on an area.  And I have to say, it's a very good question, and it basically boils down to one thing:

When in doubt, use ice.

In fact, I rarely tell my patients to put heat on an area unless it is a chronically tight muscle that needs a little coaxing into relaxation.  I know, heat usually feels better than ice, but the problem that I have with heating a general area is the effect that it has on swelling.

Now, don't get me wrong, swelling is an essential part of the healing process.  Without some swelling, your body would not be able to repair the damaged structure.  However, when you put heat on an area that is already swollen, it causes more fluid to go to that area which can increase the pressure and pain in the painful area.

If a patient and I find that ice is not working for the area, I usually tell them to do both.  You can put heat on the area (best form would be a hot bath or hot tub) but then put the ice on afterward, and always end with ice.  You will still get the relaxing feeling from the heat, but also the anti-swelling effect of the ice.  This alternating of heat and ice can actually help the flow of the fluid that is bringing healing components to the damaged area.

So why err on the side of ice?

It has to do with the swelling in the area.  When your body gets injured, it needs to send fluid (swelling) to that area to help it heal.  The issue with that is most people don't move correctly when hurt.  When this happens, that swelling stagnates in the area and can cause issues such as an increase in pain, irritation to nerves, and/or decreased mobility.  And correct mobility in an injured area has been shown to help in the healing process and help prevent issues down the road

It also helps that ice dumbs down and numbs the pain a little bit.

It boils down to this.  Anytime you injure your body, it's essentially like spraining your ankle.  I guarantee you will not see a coach or an athletic trainer put heat on that sprained ankle.  They put ice on it to keep the swelling at a manageable level so that they are able to prevent immobility to the injured joint.

So, the next time you get an injury, put some ice on it.  Just remember that 20 minutes should be plenty of time, but you will need to do it more than once.  Give yourself at  least a 40 minute break before you put the ice on again.  An BE SURE to have some sort of barrier between your skin and the ice.  For instance, a t-shirt works really well. 

And if you want to do a little gentle massage of the injured area while icing, fill up a little Dixie cup with water, freeze it, rip the bottom of the cup off so that the ice is exposed, and rub the hurt area with the exposed ice for about 10 minutes making sure to keep the ice moving at all times. 

(In this picture, they ripped off the top.  I find it easier to rip off the bottom, that way, the ice won't fall out, and you can put the leftover ice cup inside another Dixie cup and place in the freezer for later)

And as always, questions and comments are always welcome.  (If you have a question that you don't want seen by other people, feel free to e-mail Dr. Mike at

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