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Ice or Heat

One of the most common questions I get asked on a day-to-day basis in my office is, “Should I ice or heat doc?” The answer is not as easy as you may think. There is so much debate about what is best that you could literally read yourself in circles and be more confused in the end. Equally confusing is that you could ask 5 different health professionals and get 5 different answers! So, what do you do? Before I go on, please speak to your health care provider regarding your specific case, as each person and injury is different and will need to managed appropriately.

To start, let me give you a personal example; 2 years ago I was working out and thought I was “the incredible hulk” (I’m not!) and thought I could lift way more weight than I should have even attempted. Half way through the movement, I heard a pop come from my left biceps tendon at the elbow (at the moment of injury, I knew I did something very wrong, but it was too late, the damage was done – ever do something like that?). Diagnosis: 50% tear of the left biceps tendon. Within a few hours, my left arm had ballooned up and become red, inflamed and deformed. Ouch! I applied a cold pack immediately following the injury over the next few days and was thankful I did – it worked amazingly well! At the time, putting a heat pack on it wasn’t even a consideration.

You can find evidence/research that would be in direct conflict with what I did – apply ice. But, it worked remarkably well for my injury. Clinically, I have had the privilege of treating thousands of people from professional athletes to the weekend warrior and can confidently say that MOST OFTEN (not always) a cold pack does the trick for NEW soft tissue injuries.

RULE #1: Apply ice ONLY to new (acute) soft tissue (muscle) injuries.

Before I go any further, I want to remind you that inflammation is a natural response to injury and is imperative for healing to take place. With inflammation, unfortunately, usually comes pain. Some argue that by applying ice or a cold-pack to an injury, you are in fact delaying the healing associated with inflammation – which is true to a certain extent. Even still, I believe the best thing to do for new injuries where you can see the “puffy”, “red” swollen area, a cold pack in alternating 15 minute intervals of on-off is still the best course of action.

CAUTION: When icing an area, avoid stretching as you could inadvertently irritate it more, as cold tissue does not move as well as warm tissue.

So, what about a heat pack?

I will occasionally recommend a heat pack when an injury has become chronic (greater than a couple of weeks old, give or take). Heating an area will actually bring blood flow (inflammation) to the area which, as I mentioned before, can be healing. Heat seems to work well for neck and back pain (if chronic and not a new injury), to at least make the area “feel” better temporarily. Most people will gravitate towards using heat more than ice due to the comfort issue. Heat feels good! The good news is that it shouldn’t be detrimental to the healing process for most injuries if you use heat sparingly.

RULE #2: Apply heat to chronic (old) injuries sparingly.

CAUTION: When an area is obviously inflamed, red, and stiff, I recommend staying AWAY from heating the area further, as it will likely worsen the problem.

Which do you prefer?

Finally, there are people who swear by using only ice or heat – black or white. I have many patients that say, “Oh, I cannot use ice, as it always makes it worse.” Or vice versa. To that, I say, “use what works best for you.” And there is evidence to show that both can work to alleviate pain, at least minimally. A study published (click here) revealed that there may be some benefit to using either, dependent on user preference and availability. Confused yet? Don’t be…at the end of the day, it comes down to preference, or, what has worked for YOU in the past!

Even those who choose to do nothing (no ice or heat), which is what I do most of the time for my own nagging aches and pains, and embrace the body’s innate wisdom to heal on its own, not worrying about whether they ‘should’ or ‘should not’, will still end up healing – most times better than those who apply either ice or heat. Remember, the inflammatory process from injury is vital to healing!

RULE #3: If unsure, do nothing and let the body heal like it was designed to.

One of the best alternatives (or in conjunction with) to using ice or heat, is to get up and move – we were designed to move and I find moving a sore joint/area often helps better than anything! Understandably I wouldn’t recommend exercising through a sore back, neck, or case of sciatica, but a good walk or gentle stretch should help you on your way to feeling better.

Be well,


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