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Should I Use Ice or Heat for Pain?

Heat applied to an ankle

Should you use heat or ice on your painful injury? The best method of solving this important riddle is to assess the nature and source of the pain. Essentially, a new injury, that is, one that you sustained within the last 48 hours, is best treated with ice. Chronic pain, or pain that you have had for a long time, is generally best treated with moist heat. Understanding the mechanisms of injury and the physiological and biochemical causes of pain helps us to differentiate the indications for applying ice or applying moist heat.

The primary rule is that you can never go wrong with applying ice. Ice calms things down and, although an ice application may be uncomfortably cold for a few moments, the overall effect is soothing. Cold decreases local metabolism and constricts small blood vessels (arterioles). Cold reduces nerve conduction velocity, that is, the speed at which nerve impulses are transmitted, and therefore reduces the number of pain signals that reach your brain per unit time. Thus, ice applications provide vasoconstriction, analgesia, and sedation. Ice is indicated for acute musculoskeletal injury, burns, insect bites, bleeding, and snake bites. Ice should not be used for gout, rheumatoid arthritis, Raynaud's phenomenon, history of vascular impairment, and cold allergies. As well, ice should not be used for a patient in a coma.

Moist heat increases local metabolism and dilates small blood vessels. Vasodilation results in increased nutrition, increased activity of white blood cells (phagocytosis), and increased removal of waste (metabolic end-products and damaged cellular structures). Moist heat provides analgesia, sedation, and reduces muscle spasms. Heat is best for chronic pain and muscle spasms. Contraindications to moist heat include acute musculoskeletal injury, area of diminished sensation, acute skin conditions, pregnancy, malignancy, diabetes, encapsulated swelling, hemorrhagic disorders, and suppurative conditions.

Generally, ice applications are used for acute injuries within a 72-hour time frame from the onset of the injury. Acute injury damages local capillaries, causing blood to leak into the spaces between cells and tissues, where it doesn't belong. Such uncontained blood causes pressure on local nerve endings, creating pain. Also, pressure is applied to nearby cells, causing extended injury and possibly cell death. Thus, limiting the amount of blood leaking out of disrupted capillaries is critical in slowing the effects and reducing the impact of musculoskeletal injury. Ice performs this function. Ice reduces swelling, reduces pain, and provides a sedative effect.

When applying ice, it's very important to avoid damaging the skin. Ice packs should always be wrapped in a towel. Ice should rarely be applied directly to the skin. Duration and frequency of ice applications is not an exact science, but a useful guideline is to apply ice for 15 minutes every two hours for a moderately acute injury, using three to four ice applications per day. However, you will know instinctively when the time is right to apply the next ice pack.

Moist heat applications follow similar guidelines. Dry heat should never be used. Moist heat packs should be wrapped in a towel and are applied for 15 minutes every two to three hours, up to several applications per day.

Recovering from injury requires your body to put forth a great deal of effort and requires support from the nerve system, the body's master system. Regular chiropractic care provides great assistance in the process of recovery from an injury. By detecting and correcting spinal misalignments and sources of nerve interference, regular chiropractic care helps ensure optimal functioning of the nerve system. Thus, regular chiropractic care helps facilitate your recovery and helps you return to your full range of activities as quickly as possible.

1McCarberg B, D'Arcy Y: Options in topical therapies in the management of patients with acute pain. Postgrad Med 125(4 Suppl 1):19-24, 2013

2Piana LE, et al: The Cold, Hard Facts of Cryotherapy in Orthopedics. Am J Orthop (Belle Mead NJ) 2018 Sep;47(9). doi: 10.12788/ajo.2018.0075

3Mayer JM, Mooney V: Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil 87(10):1310-1317, 2006

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  • "I can't believe how professional, efficient, and effective the entire staff is at CHAWC. I am out and on my way to work in a short time, while achieving maximum results."
    Jodie Richmond, VA
  • "I have suffered from lower back and sciatica pain for over two years now. Prior to my visit to this practice, I have been x-rayed, tested, MRI, countless specialists visits and not to mention the costs associated with all of that. I have been in chiropractors' offices before and they usually adjust my back and the pain decrease for a day or two but never goes away. Dr. Cally was thorough, knowledgeable in her specialty, and kind. Although, I was skeptical at first but, Dr. Cally's knowledge put me at ease. Needless to say, now I am pain free. Not only she is good with her patients but once you walk-in that office you will feel the good vibe from her staff (happy employee means happy customer), which tells me she is treating her staff good as well. Thank you, Dr. Cally for all you do. You and your practice are hard to find these days. Keep up the good work."
    Dr. Beygatt, PhD
  • "Dr. Jo has been such a blessing and resource for my health and my back. I have been doing chiropractic for about 15 years, and Dr. Jo's treatments and home therapies have seriously changed my life and my back and neck in the past year. I am in awe of how much better I feel overall and so appreciate their dedication to my health and well-being!"
    Joy
  • "Dr. Cally Parks has so greatly impacted my overall well being! Her thorough and compassionate care has lead me to feeling my best. I highly recommend her to anyone with any back or hip pain."
    Megan
  • "I can't say enough good things about Dr. Jo and the rest of the staff. I've never enjoyed a medical treatment so much. Every time I come in, I feel like I'm seeing good friends. Chiropractic Care has changed my life for the better, and I believe the philosophy at CHAWC has been key to my success. I have recommended CHAWC to many and will continue to do so!"
    Sunni
  • "I am very impressed with the quality of care and knowledge of Drs. in this clinic. My quality of life has improved drastically and I am able to do things now that I have not in a few years. Dr. Cally and Dr. Jo have made a difference for me. Laura and Julie are so welcoming, as well as willing to work with your schedule so you can reach your health goals. Thank you Chiropractic Health and Wellness Center!!!"
    Ashley