To Heat or Not to Heat

When do I use heat and when do I use ice for pain relief? This is a question we hear all the time, typically from new patients.

When new patients are coming into our office for acute care they very frequently have spent days or weeks, it makes me cringe to say this, sometimes even MONTHS trying to manage pain. The application of ice or heat is one of the most common pain management techniques.

Before I get into when to use ice and when to use heat I just have to get something off my chest–

Pain is not something to be managed! Pain is our body’s cry for help. Typically your body will live in a state of dysfunction for a long time before sending you a pain signal (that’s why we tell you pain free does not equal subluxation free). Once your body sends you a pain signal you have a big problem. You have tissues that are damaged and have probably been damaged for some time now. All this to say, when you are in pain don’t just manage it. Don’t just see if you can “work through it”, “handle it” “suck it up”, “wait until it goes away”, etc. When your body is sending your brain a pain signal, pay attention and get to the root of the cause so that your body can begin healing (hint hint: CALL YOUR CHIROPRACTOR!).

Okay now that I got that off my chest we can talk about heat and ice.

I know most of you don’t live with a chiropractor and you might have to wait a few days before you can get an adjustment following a new injury. When that happens this is a guide for you on how to apply ice and heat.

Within the first three days of a new or acute injury you should ice, ice, ICE! Do not apply heat. If you have an injury causing your muscles to tense and maybe even muscle spasms, you might think that heat will help the muscles to relax. That is generally not the case. Heat may feel relaxing while you are applying it but once you remove the heat things tend to go down hill and pain increases quite a bit. Why? Because pain is caused by inflammation and swelling. The swelling is primarily increased blood volume. This increased blood volume causes irritation to the nerve tissues. This in turn sends the pain signal to your brain and you realize “OW! this hurts!” So when you add heat to an area of recent injury that is already inflamed it draws more fluid (blood) to the area, causes more inflammation, more tissue tension and more pain.

On the other hand, ice causes blood to withdraw from the injured location, decreasing swelling and inflammation with the result being less pain. Ice also has a numbing effect on the nerve endings which also reduces pain. Using ice to treat an acute injury, especially in the first three days of the injury can decrease pain and may also help the injury to heal more quickly. After the first three days the application of ice is less effective at promoting healing but it may still help to mitigate pain.

The standard protocol for using ice is to put an ice pack on for 20 minutes and then take it off for 20 minutes and repeat. Often it’s easier just to remember to ice for 20 minutes at the top of every hour. You don’t need to do this all day but when you have an acute injury it is good to do this cycle 3 to 4 times a day.

My favorite way to ice if you have a small acute injury (say and elbow or a shoulder) is to do an ice massage. Just take an ice cube and massage it on the area of pain until the ice cube is melted. This helps the cold to penetrate a little bit deeper and has a greater effect.

When Can I Use HEAT?

On an old injury. If you have an old injury that causes joint pain or muscle stiffness this is when you may want to use heat to bring some more blood into the chronically damaged tissues. My preferred methods of heating are either a warm shower, a hot tub, or take a hand towel soak it in hot water stick that in a plastic bag (so you don’t get soaked) and apply that to the nagging area.

And Above All Else!
Please call your chiropractor. Don’t just manage your pain with ice, heat or NSAIDs. Pain is a signal from your body telling you that it needs help. Let your chiropractor get to the cause of the problem so you can heal rather than “handle”. Life should not be about getting by, it should be about getting well, and staying there. Living a life of wellness is the kind of life I want to live…and you should too!!


Brandon, Rutland and Randolph VT

Font Resize