Temperature Issues

Ice or heat? What to use when treating muscle aches or injuries.

By Stephen Hanks

October 2005

Lost in the shuffle amid all the talk about whether to treat serious pain and inflammation with pharmaceuticals or more natural remedies has been the answer to this question: What can we do to treat minor muscle aches and injuries using topical treatments? If you’ve ever pulled a hamstring muscle or turned an ankle when jogging, nursed a sore shoulder after playing tennis or been nailed by a line drive in a pickup softball game, your biggest dilemma has been figuring out when to use ice or heat to quell the discomfort.

You’ve probably heard about baseball pitchers who ice their shoulders before a game and basketball players who ice a painful knee prior to opening tipoff. That should be a tip- off to the obvious: that ice decreases inflammation and, by extension, pain. Ice constricts the blood vessels and reduces the blood flow into the area of the body that is being overworked and inflamed, which is why athletes swear by it and why you should always use it immediately after an acute injury or after activities that aggravate a chronic ailment.

Icing Out An Injury

Expert opinions vary on the length of time needed to ice an injury, but it should be based on the depth of the injury and the amount of fat between the skin and the injured area. The general rule of thumb is to apply the cold stuff for about 20 minutes at a time, a few times a day, for 48 to 72 hours, depending on the severity of the swelling. Over-icing one spot invites frostbite, which can also occur if you apply the ice directly without any kind of enclosure, such as a ziplock bag. You can also use a bag of frozen peas or corn, which offers the dual benefit of decreasing your pain and defrosting your dinner vegetables at the same time.

Those pop-and-shake ice packs that come in first aid kits aren’t very effective in reducing swelling and speeding recovery. They are fine in a pinch when nothing else is available, but whenever you can use actual, right-from-the-freezer ice.

In treating an acute injury with ice you should also incorporate the other elements of the RICE recovery method. No, it wasn’t named for the current US Secretary of State, but is a self-explanatory acronym meaning Rest, Ice, Compression and Elevation.

Turning Up The Heat

So, why wouldn’t you use heat immediately after suffering an injury? After all, heat can be so soothing and comforting. But heat increases blood flow to an area, which would increase pain and swelling. The time to up the blood flow quotient is after you’ve finished with your ice treatments (up to two weeks, depending on the injury), when the bleeding and swelling in the area is over. Using heat at that point stimulates the removal of waste products in the injured spot, helping to reduce pain, soreness and stiffness. Heat also increases the flow of nutrients and oxygen to the damaged tissues.

Heat treatments can be applied several times a day, but should last no longer than 10 to 15 minutes at a time. You can apply heat in the form of heating pads, moist hot towels,  heat creams massaged into the area or microwavable heat packs. Never apply heat packs directly to the skin or while sleeping, or the resulting burns will make your original injury seem tame by comparison.
If after two weeks you still need to apply some soothing comfort, you can go with either ice or heat, whichever gets you closer to being active once again.

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