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As a doctor of physical therapy, I answer a lot of questions everyday.
Of everything I get asked, without-a-doubt, hands-down, the most-common question is … “Should I put heat or ice on my injury?”
We all know that thermal modalities can help alleviate pain, stiffness, swelling, etc; but sometimes it’s hard to know which exactly is the right one to apply at the right time. There are a lot of different opinions out there and sometimes it’s difficult to discern which one is right for you.
Well – you’re in luck! Today I wanted to share with you the answer to this question and hopefully give you some advice as to which one will be the best for you.
SCROLL DOWN AND PUSH PLAY ON THE VIDEO BELOW TO LEARN THE BENEFITS OF THERMAL MODALITIES!
Heat: The two primary effects of heat are 1) increasing blood flow and 2) promoting relaxation.
The warmth causes vasodilation of capillaries in a given area – that means your blood vessels get wider and more blood can come into an area.
With this increased blood flow comes oxygen, platelets, collagen, etc, and other essential building blocks in tissue repair and healing.
For these purposes, I typically recommend heat for tight, sore muscles. Body aches also respond well to heat. Anytime there’s pain in an area without a lot of inflammation (swelling and redness), heat can be a very effective means of decreasing pain.
Some common pains that I will typically apply heat to include stiff, achy low back pain, neck pain, and occasionally shoulders if they meet the right criteria.
Ice: I reach for the cold packs for essentially three reasons: 1) decrease inflammation, 2) acute pain, and 3) to decrease nerve conduction velocity.
- Ice is an amazing anti-inflammatory.
- After an injury the body elicits an inflammatory response which is essentially the signal for the healing process to begin to occur.
- Inflammation, in moderation, is essential and vital to healing.
- Unfortunately, injury it is often accompanied by pain.
- Ice is a great way of decreasing the magnitude of this inflammatory response and thereby decreasing pain as well.
- Ice also decreases nerve conduction velocity.
- Simply put, the electrical signal from your injury to your brain is slowed down by the cold.
- This means you don’t feel the pain as badly as you would otherwise.
Whenever there is an acute injury to the body (sprains, strains, muscle pulls, acute overexertion, etc.) reach for the ice pack.
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Finally, a quick word about neural pain. The most common example of nerve pain that most people are familiar with is sciatica. This pain is the shooting, electric, sharp pain that starts in one area and radiates to another (i.e. sciatica: starts in the back/buttock area and shoots down the leg). Ice is typically better at decreasing this nerve conduction velocity and decreasing radicular pain.
How long should I apply heat or ice?
A good rule of thumb to follow is 20 minutes on and then 20 minutes off before repeating again. This allows adequate heating/cooling of the tissue while the modality is applied and then adequate time for the temperature to regulate again before the next application so we’re not worried about burns and frostbite.
So what’s the best for you?
Well, it’s important to note that everything I just mentioned in this post is textbook and theory.
Unfortunately in the world of medicine that means it’s correct approximately 60-90% of the time.
That being said, what’s supposed to work for one injury may not always work for you. If one modality doesn’t elicit the response you’re after you might try the other to see which is more effective.
Some other common questions I get about heat and ice include…
Do you put ice or heat on a pulled muscle? – If it happened within the last week, reach for the ice pack to decrease the pain and inflammation. After that, heat will be better to promote blood flow and healing in the area.
Is hot or cold better for nerve pain? Again – ice is your go-to here. It should slow down nerve conduction and help the area feel better.
Is it better to ice or heat a sore foot? Most often, common foot pain comes from overuse. If you’ve spent too much time on your feet in a given period of time, reach for the ice pack to decrease some of that inflammatory response.
Is it better to ice or heat a sore knee? Typically I’ll reach for ice when it comes to knee injuries. It’s a joint where inflammation is common and most injuries in this area are joint-related instead of muscular (inflammation instead of sore, tired muscles).
I hope this helps you out! The right modality can really go a long way in helping to decrease your pain and help you feel better. Try them out and let me know what worked fro you!
As always I appreciate your comments and questions. The majority of my favorite blog posts come from answering reader questions. If you have anything I can potentially help you out with don’t hesitate to ask! Leave me a comment below or email me at jared{at}toneandtightenfitness{dot}com.
Make it happen,
Jared