• Dr. Jennifer Nicole Falk

When to Use Heat vs Ice for Pain



After a long run, do you ice for recovery? How about after an injury? When do you choose heat over ice? The correct answer may not be an easy one, but there are some general guidelines that can be followed to know when you should be using one versus the other.

At its simplest form, it is recommended to use ice for new, or acute, injuries and use heat for more chronic issues. The reason for doing one versus the other comes down to the goal you are trying to achieve. After a traumatic injury, the involved area tends to swell. If you were to add heat to that area, it would be like adding fuel to fire. Instead, you want to cool the area down and decrease the swelling by icing it. With more chronic, or long-standing, conditions, such as osteoarthritis, it may be more beneficial to warm up the affected joints, which can help decrease stiffness.

Check out the types of cold and heat therapy below, the reasons for using each, and when it is actually recommended to avoid them.

COLD THERAPY

Purpose:

  • Cools skin temperature (1)

  • Decreases swelling and blood flow to a specific area

  • Decreases pain by temporarily increasing pain threshold (1)

Types:

  • Body part immersion (e.g. ice or whirlpool bath)

  • Ice packs

  • Ice massage (e.g. frozen water bottle)

Uses:

  • Acute/new injuries – (e.g. ankle sprain, broken foot, etc)

  • Apply immediately after injury

  • Likely most effective within first 1-2 weeks after injury

Avoid In:

  • Diabetes

  • Peripheral neuropathy (loss of sensation)

  • Vascular disease (poor circulation)

  • Stiff joints

HEAT THERAPY

Purpose:

  • Vasodilation (increases blood flow to area)

  • Relaxation, and improved flexibility, of soft tissues (i.e. muscles, tendons, ligaments)

  • Improve joint stiffness

Types:

  • Body part immersion (e.g. warm water soaks, hot tub)

  • Heating pad

Uses:

  • Before athletic activities for injury prevention (3)

  • Joint stiffness

Avoid In:

  • Diabetes

  • Peripheral neuropathy (loss of sensation)

  • Vascular disease (poor circulation)

  • Over skin rashes or open wounds (2)

  • Areas of significant swelling

Summary:

As you can see, there are many ways to perform cold and hot therapy. There are also multiple indications for each one's use, as well as reasons for avoiding each. Hopefully the information above, though, has made it easier to determine when ice vs heat should be applied. Remember, neither ice/ice packs nor heat/heat pads should be applied directly to the skin, and, if you have any questions or concerns related to your health, contact your own healthcare professional prior to trying either of these therapies.

Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor or your own healthcare professional for questions or concerns related to your health.

References:

1. Ernst, E., & Fialka, V. (1994). Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. Journal of pain and symptom management, 9(1), 56-59.

2. Gotter, A. (Reviewed 2017, Feb 2). Treating Pain with Heat and Cold. Retrieved from http://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#applying-cold-therapy5.

3. McLean, D. A. (1989). The use of cold and superficial heat in the treatment of soft tissue injuries. British journal of sports medicine, 23(1), 53.

#icing #coldtherapy #heat #heatpad #footpain #heattherapy #footinjury

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