Should You Use Ice or Heat?

Those who have pain wonder whether or not to use either heat or ice.

The reality is there’s now simple answer as you guessed it, ‘it depends’.

However, I’m going to try to give you some insight on when and more importantly why you should use one versus the other or neither.

First, in order to understand when and why you should use heat or ice, we need to discuss what inflammation is.

If you’ve heard of or have ever been given a diagnosis that ends with -itis such as: tendinitis, bursitis, arthritis, bronchitis, tonsillitis, etc. then that’s the Latin suffix us doctors use for inflammation. Now these can be caused by trauma or repetitive motions (which is typical for things like tendinitis and bursitis), infection (which is typical for things such as bronchitis and tonsillitis), or an auto immune process (like rheumatoid arthritis).

Your body has only one mechanism to deal with either infections or injuries (and in cases of auto immune conditions essentially your body mistakenly treats it’s self as an infection) and that response mechanism is the inflammatory process. Which always has the following 5 Cardinal Signs:

1. Redness
2. An increase in temperature
3. Swelling (aka edema)
4. Pain and finally,
5. A loss of function

When an injury or infection occurs your body causes an increase in blood flow to the area in order to bring more white blood cells to the area (to deal with the problem and start the healing process). At the same time your body restricts fluid drainage (to help prevent the possible spread of an infection). Which causes the above signs.

Because your body has only the one response it naturally goes with the worst case scenario which is an infection (which potentially can cause a loss of life) so in these cases inflammation is a good thing.

However, for injuries and auto immune conditions inflammation can cause a lot of problems.

When ice is applied it initially signals a decrease in blood flow, which then reduces inflammation. However, after about 25 minutes or so (depending on the thickness of the area, amount of fat, and distance of the blood vessels from the skin’s surface), the opposite starts happening and an increase blood flow occurs to prevent any tissue damage (frost bite) which will then, of course, increases inflammation.

If heat is used this will (as you probably figured out already) also increase blood flow and inflammation.

So for injuries and auto immune conditions (when inflammation is actually present) icing the area for 20 minutes every hour or so may help.

However, in cases of infections and joint stiffness and/or muscle tightness without pain or swelling, using heat (or icing for over 30 minutes) can be helpful.

However, if you have any underlining conditions that may cause a problem with your ability to sense temperature changes (like diabetes) or if you are unsure of your diagnosis please seek the appropriate advice from your health care professional before you try anything.

I hope this post helps shed some light on why, when, and whether or not to use heat or ice and if you have any further questions or comments feel free to leave them below.