September 03, 2015

Ice or Heat?

Articles by Dr. Erdman are for informational purposes, and are not to be taken as specific medical advice.

Do I use heat or ice, Doc? This seems to be the most commonly asked question in my office. People find it difficult to remember when to use which one.

Applying ice or heat can provide relief from injuries, aches and pains, but they cannot be used interchangeably. In a general sense, ice works best for sudden injury, while heat is best to soothe longer term aches and pains.

The primary effect of ice is to narrow blood vessels, which helps prevent blood from pooling at the injury area. Exudates of injury adds to the inflammatory reaction causing swelling and delayed healing. Elevation of the body part is somewhat of a help in reducing this swelling also.

If you’re an athlete you’ve heard the common pneumonic RICE: rest, ice, compression and elevation. The general rule is to do this for 20 minutes every hour as possible for the first 48 to 72 hours.

Here is where I deviated from ‘traditional’ icing applications. In my office I have patients with severe acute injuries, follow a very new guideline called Long Term Cryotherapy (LTC). Traditional ice techniques with frozen cold packs or straight ice are used for 20 minutes per hour. This is obviously meant to keep dumb people from freezing their skin and doing more damage. In LTC, it has been discovered that continuous icing for 2-6 hours is a huge help with sudden injuries, especially in the low back or neck.

With LTC, resealable bags of an ice and water solution are used instead of solid ice. By doing it with slushy ice bags, the temperature of the solution is above freezing, around 34 degrees, thus preventing even the most inept self-medic from getting frost bite. I have people place the bags of ice water directly on the skin since there are no worries about freezing the skin. You could use a thin cloth if you’re still a little reticent, but it does reduce the effectiveness of the technique a bit.

The goal of LTC is to reduce the tissue temperature by 2 degrees  at a depth of two inches. This takes a while to do and the thicker the body part the longer it takes. In the neck or a limb, it may take just 1-2 hours, but the lower back may take 4-6 hours.

Not only do you benefit from the reduction of swelling and exudates with LTC, but another maybe even stronger benefit is pain reduction. It only makes sense that if the area is numbed, you feel less pain. In fact, the pain relief with LTC has been found to be better than over the counter pain relievers.

Generally, any time there is inflammation and swelling, use ice.

Heat, on the other hand, is applied to long term conditions without marked edema. Heat brings blood flow to the area by dilating blood vessels. This promotes increased oxygenation and healing of tissue, as well as increasing waste removal from the area. Heat soothes pain while increasing flexibility.

Heat is mostly recommended for use in 20 to 30 minute intervals, although long term heat exposure in saunas and hot tubs can also be beneficial.

Therapeutic heat is used for chronic arthritic conditions and mild overuse injuries (even in the early stages). By mild overuse injuries, as an example, I mean let’s say you haven’t thrown a baseball for 5 years, yet your grandson wants to toss some ball. You do it for 30 minutes without really feeling any negative affects…until the next day when you can’t comb your hair over your bald spot. That is a time for heat for those overused muscles in the shoulder. There was not a real injury, just over worked muscles.

I have an easy saying to help you if you can’t remember, “Ice will never hurt you.” By this I mean if you should be using heat and you use ice, you won’t damage anything; it just won’t help you feel any better.

But, if you use heat when you should be using ice, it will almost always worsen your symptoms or condition. 

Unfortunately, every month a patient walks in the door practically crippled. Many times the low back injury happened a week ago, they went to their medical doctor, and he said, “Its just muscles, put heat on it!” That guy is now saying “I’m worse”, and can hardly move his torso at all. He has just set his recovery back by 1-2 weeks simply due to using heat when ice was the appropriate remedy.

Reach for the ice bag first if you don’t know what to do, at least it won’t hurt you

I hope this helps you remember the correct procedure when the pain starts.