To Heat or to Ice? That is the Question

Whether you’ve got active kids at home, an extreme sports addiction, or just a propensity for high heels in the city, chances are you’ve experienced some acute injuries that need more than just a kiss to feel better. But when rolling an ankle, pulling a back muscle, or straining a shoulder, it can be difficult to determine when to ice it, and when to heat it.

For some, this is an age old debate, but there is some science behind it. Here’s what you need to know when dealing with an injury at home — including when to call the doctor!

Ice Basics: For Acute Injuries with swelling / inflammation

Ice packs are most commonly used within the first 48 hours of an injury if swelling or inflammation has occurred. The ice helps to restrict blood vessels to reduce swelling and manage pain. Acute injuries like a sprained ankle or pulled muscle, as well as conditions like tendinitis, will benefit from ice.

Tips:

• Make sure to always have something in between the ice and skin to prevent burns, like a towel, or a plastic bag (a bag of frozen peas for instance is perfect for conforming to injuries and easily re-freezing.
• Never ice an injury for longer than 30 minutes at a time — most clinicians suggest 20 min on, 20 min off.
• Never use ice on an infected injury.

Heat Basics: For muscle tension and spasms

Heat is most commonly used for chronic muscle conditions to loosen and relax the tissues. Heat is great for overuse injuries, back and neck tension, and chronic pain like arthritis or tendinosis.

Tips:

• Do not use heat when swelling is involved (as it will draw more blood to the injury, making swelling worse).
• Do not heat an area for long periods of time, especially not while sleeping.
• Make sure to control temperature to avoid burns.
• When using heat to treat chronic injury from overuse (such as sports injuries), make sure to only use heat treatments before activity — never after (as swelling or acute inflammation is likely to have occurred).

When it comes to muscles, heat vs. ice can be especially difficult to determine, because ice can often make muscle tension or spasms worse, but it can also be an effective remedy for muscle injuries, like pulls, tears, or sprains. If there is actual trauma to the muscle (usually signified by a quick, severe jolt of pain in the muscle), stick with icing during the first 48 hours to help reduce swelling and damage done to the tissue. For older muscle injuries, and chronic pain or tension, heat is the best bet to keep the tissue loose and help to control pain.

Finally, it’s important to know when you have to throw in the towel (whether it be hot or cold) and call the doctor. With acute injuries to ankles, knees or wrists (which are commonly strained, sprained, and fractured), it’s a good idea to see a doctor if any of the following occurs:

• Significant swelling that does not go down after a few sessions of icing.
• There is visible bone misalignment (which can be difficult to see with added swelling)
• Any discoloration, if the injured area turns black or blue, or even bright red.
• Bleeding or deep cuts (which may need stitches, and should never be iced or heated)
• Numbness, or inability to move the joint, or bear weight.

Resources:
https://www.scoi.com/patient-resources/health-articles/should-you-ice-or-heat-injury
https://www.painscience.com/articles/ice-heat-confusion.php
https://health.clevelandclinic.org/2014/08/should-you-use-ice-or-heat-for-pain-infographic/

Written by Olivia Murphy