Heat vs. Ice Which is Best for Your Injury?


Heat vs. Ice Which is Best for Your Injury?
Healthy Living - September 8, 2015
JP Stowe, ATC
Have you ever encountered the problem of deciding whether to use heat or ice for your injury?  The ice numbs the area and takes away the pain, yet the heat feels so good and relaxes you.  There are research driven methods to make that decision a little clearer for you, and even some research that states ice may not be as helpful as we thought.
Let’s start with ice. The best way to apply ice is by using ice cubes in a plastic bag directly on the skin; if you only have pre-packaged chemical packs or gel packs available there should be a barrier placed between the bag and the skin, like a wet paper towel. The reason being is that ice cubes reach a thermal temperature to freeze and maintain the temperature of the environment. On the other hand, chemical packs and gel packs can reach temperatures lower than freezing which could be potentially damaging to skin. When cold is applied to the body, blood vessels become smaller and the blood flow to that site is significantly decreased. The cold also acts on the nervous system disrupting the sensation of pain being transmitted to the brain.
With heat, the best rule of thumb to remember is if it feels too hot to touch, then it is too hot to apply anywhere on your body. When heat is applied to the body it does the exact opposite of ice. Heat causes blood vessels to widen, allowing more oxygen and nutrient rich blood to make it to the site. Heat also reduces muscle spasm which is a protective mechanism that makes our muscles feel sore and tight. This decrease in spasm allows for greater range of motion, making performance and stretching more effective. Moist heat is by far the best, most penetrating type of heat.
So now to the real question: which should you use? The determination of heat vs. ice is all about timing and may not be what you thought. When we suffer an injury, our amazingly tuned bodies immediately start the inflammation process and go into repair mode. Our body rushes nutrients and chemicals to an injury site to quickly begin cleaning and repairing the damage. This flow into the area is why we see bruising and swelling when we get hurt. This isn’t a bad thing, and recent research has shown that ice treatment may actually be more harmful than we once thought. Ice slows down the blood flow and the influx of macrophage cells that clean the site and inhibits a very important hormone, IGF-1, from being release by the macrophages. This IGF-1 hormone aids in the repair of damaged tissue and is sorely needed. Due to this, ice may be the best treatment choice for immediate pain management, but long term use to decrease swelling may actually be a bad idea and will delay the healing process of the body.
Heat is a great option for chronic (long term) soreness, stiffness, and pre-game preparations. Because of its ability to increase blood flow to an area, heat will help relax muscle spasms on a day you just worked too hard or when you want to get a little more out of that yoga pose. Now, heat may actually be used a bit sooner for those acute injuries.
It is still recommended to use ice as the best option acutely after an injury (first 12 hours) due to its pain relieving qualities. However, current research suggests that early motion, elevation, and heat application are just as important. Ice and heat applications should be for at least 20-30 minutes in order to reach maximal tissue depth.  In the next few years, don’t be surprised if healthcare clinicians get rid of ice treatment altogether.
Hubbard, TJ, Denegar, CR, (2004). Does Cryotherapy Improve Outcomes With Soft Tissue Injury? Journal of Athletic Training, 39(3):278-279.
Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999
Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014