Heat or Ice for Pain?

Heat or ice or cold for pain and injury by Leamington Spa osteopath Emma Lipson

Many of my osteopathy patients ask me whether it is best to use heat or ice to relieve their pain and speed recovery. The answer is, it depends on the type of injury, how long you have had the pain and to some extent what feels better.

The general rules of thumb are:

  • Ice for acute pain or a new injury when there is swelling. Eg pulled muscle or ligament sprain
  • Ice for the first 3 days post-injury or until inflammation has died down.
  • Ice reduces inflammation, commonly found in injured joints, tendons and muscles.
  • Heat is usually more effective for chronic persistent pain.
  • Heat relaxes sore, overworked muscles and muscle spasms.

There are however some exceptions….

Arthritis: Although arthritis is not an acute injury,  many sufferers find ice soothes their symptoms. Others however, find heat helps. This probably depends to some extent on whether there is an inflammatory flare up or not.

Overuse or repetitive strain injuries like carpal tunnel syndrome, tennis elbow, iliotibial band syndrome, supraspinatus tendinitis, shin splints or plantar fasciitis. Many find ice eases pain associated with these conditions. This, despite their chronic nature, and that inflammation is invariably absent, apart from at the time of onset.

Low back pain: the jury is out on this one also. Research shows similar effectiveness for both heat and ice. My advice would be stick to ice if you have a recent disc injury or sacro-iliac joint problems. Otherwise go with what feels best.

Still not sure whether you should be using heat or ice?

  • Always use ice over heat if there are any signs of inflammation or swelling. Heat can exacerbate inflammation, delay healing and increase your pain. Not sure how to tell if inflammation is present? Look for the physical signs of redness, pain, swelling and  heat, and be aware of when your pain worsens. Pain caused by inflammation usually increases after rest (ie. first thing in the morning or at night), and reduces with gentle activity. More strenuous exercise however can make inflammation and pain worse.
  • If you have a muscle strain or tear, use ice for the first three days, then switch to heat, particularly to warm up the muscle before attempting exercise.
  • Ligament sprains – use ice for the first three days or until inflammation subsides.
  • If you already feel cold, ice will probably tense you up further. Likewise if you already feel too hot, heat is likely to make you feel more uncomfortable. Your brain may interpret these temperature extremes as a threat, and feeling threatened is a proven factor in making chronic pain worse.
  • Listen to your body. If ice makes you feel worse, then try heat and vice versa. Your body is very clever and has a natural tendency towards healing and health.

How it works

Heat stimulates blood flow to the site of injury once inflammation has subsided. This increases the supply of oxygen and nutrients to the damaged tissue, vital for optimum healing. Heat also relaxes painful muscle spasms which further restrict blood flow and healing. Increased blood flow can also help prevent the build up of lactic acid that can accumulate in overworked muscles. If left to build up, lactic acid causes painful muscle ache.

Ice: inflammation and swelling is your body’s natural response to injury and crucial to the healing process. The chemicals produced in inflammation however, along with the resulting  pressure build-up, aggravate nerve endings causing pain. Ice narrows your blood vessels, therefore reducing blood flow to the affected area. This helps to reduce the build up of inflammation in the injured region, therefore alleviating pain.  It is important however to only ice for periods of up to 10mins (see below), to ensure that the inflammatory healing process is still allowed to occur.

How to do it

  • Heat:  use a hot water bottle wrapped in a towel, heat pad, sauna, hot bath or sauna (remember to keep hydrated).
  • Ice: use an ice pack or bag of frozen vegetables wrapped in a thin tea towel. Apply to the affected area for a maximum of 10 mins per hour. Avoid direct contact with the skin to prevent ice burns. Repeated hourly use for 10 mins per hour can be extremely effective.

What else can I do to speed my recovery?

If you have an acute injury or chronic pain, ice or heat alone will not usually be sufficient to get you better. It is always best to talk to a professional such as an osteopath about the best treatment approach for your situation. They will do a thorough assessment and put together a treatment plan which will ensure a quicker recovery and reduce your risk of recurring pain or injury. Call us today to see how we can help with joint pain, muscle or tendon injuries, arthritic pain and much much more.

What do you think?

I would love to hear your thoughts on this blog. Have you found it useful? Do you find heat or ice more effective and when? Or do you think its a waste of time?  I’m also always looking for new blogging subjects around health, wellness and osteopathy, so suggestions please!

Emma Lipson is Principal Osteopath at Feel Better Osteopathy in Warwick, Warwickshire.