Ice vs. Heat?

This is a common one that comes up in our office all the time. There are a couple questions that you have to ask, but as a general rule ice is better than heat. Ice reduces inflammation which is generally responsible for the sharp pain you may be experiencing. Many times we use ice to aid the healing process. There is no healing without inflammation! The problem is that inflammation is not very efficient on its own, it tends to all rush in and try to fix the problem all at once, creating a gridlock-like situation in your blood vessels. Ice closes down the blood vessels, squeezing the inflammatory cells and blood products out of the area. This allows new, fresh blood products and cells to come in and heal the injured area. In this type of icing, the number of cycles that you have the ice on and off is critical to how well the ice works. The more cycles you can ice, the better, and faster, the area will heal. Think of it as wringing the soap out of a sponge. The soap never really gets rinsed away if you simply run water over the sponge, but if you squeeze the sponge you can clear the soap very quickly.

Heat is appropriate in some situations. It is generally easy to tell when to heat by the type of pain you are having. Sharp or stabbing pain should always be iced, dull or achy pain that does not have any kind of sharp component (like with certain movements) can be heated. This type of pain is very common after a good workout, but wait about 24 hours after the workout to make sure there is no sharp pain which would indicate an injury. It is also appropriate to heat an area after an injury as long as ALL of the sharp pain has passed. Heat will allow the blood vessels to expand, which will clear any lactic acid built up in well worked muscles. It will also make the muscles, tendons, and ligaments more flexible which will relieve a lot of stiffness. Stretching after heating is a great way to increase flexibility without risking additional injury to the soft tissues. A hot tub is one of the best ways to heat an area, but if one is not available a long, hot bath will do just fine. Even a long shower can be a very beneficial method of heating an area. A dry heating pad placed over an area is the least effective method of heating. Without the moisture the heat never really penetrates the skin to get to the muscles below. Some heating pads come with a wettable cover to supply moist heat, but I am not a big fan of mixing water and electricity.

I hope this has been educational for you. As a reward for reading this post tell us the secret password: CHATTANOOGA for $5 off of one of our high quality ice packs that we have for sale in the office.

12 replies
    • Dr. Moulder says:

      When the ice pack is on for too long your body thinks that your skin is going to freeze. The reaction to this is that your body sends in more blood and blood products to prevent frost bite. This is exactly the opposite of what we are trying to accomplish (moving blood and blood products out of the area) with the ice in the first place. Your best bet is to remove the ice pack as soon as the area is numb (when the stinginess of the ice pack has gone). It may even be helpful to set a timer to help you remember. Thank you for a great question.

    • Dr. Moulder says:

      Good question. Icing should be done as long as there is sharp or stabbing pain, so it really depends on how quickly you heal. After the sharp pain is gone, it would be fine to stop icing and even use moist heat if necessary. This could take as little as 24 hours for very minor muscle strains, and could be as long as a month for major sprains involving ligaments that surround the joints. Because muscles have a better blood supply they typically heal more quickly than ligaments that have a poor blood supply and mostly rely on diffusion (being bathed in fluids) for their nutritional/healing needs. Some people also have a tendency to re-injure themselves because they cannot stop the activity that is causing the sharp pain. This could also prolong the amount of time icing is necessary.

  1. mike press says:

    This explains nicely why I was told to use an ice pack for my back. It did not make sense to me as I have previously been told to use a heat pad instead. The cold pack did help.

  2. marty says:

    Thanks for the great info! As a marathoner, I’ve always heard that you should ice your legs after a long run. Since dunking myself in an ice bath after hours of running is about the last thing I want to do, is a soak in a hot bathtub okay as long as I have no acute pain (i.e., only achy, tight muscles)? Does the increased blood flow from the heat not also reduce inflammation and promote muscle repair?

  3. Dr. Moulder says:

    A marathon is a bit different than some weekend warrior’s soreness after a Saturday morning of basketball. In a marathon there is so much lactic acid produced in the bellies of the muscle that if it is allowed to stay in the muscle recovery from the race can take much longer. It is also hypothesized that there are many microscopic tears within the muscle tissue that it really is more like an acute injury than plain old muscle soreness. A soak in a hot bath would bring more blood products to the area, but your body has a much harder time removing interstitial fluid from an area than it does getting arterial blood to the same area. Heat does not reduce inflammation, in fact, it usually makes inflammation worse or makes it last longer.

  4. Cristall says:

    Dr. Moulder, given my situation with thoracic outlet syndrome as background to keep in mind, should I ice or heat my neck today? Becky worked it for 90 minutes and it was GREAT but now the muscles are sore – not a sharp pain, but just an ache. The post above makes me think moist heat would be OK, but I wanted to check anyways since my neck has been such an anomale of everything I thought I knew about caring for muscles. The back of my neck when I’m resting is just an achy, but if I reach my arm over my head, there is still a stabbing pain in the scalene. Thoughts?? (Is there a better place to post a question on this site?)

  5. aiena says:

    hi …just want to know what to do if dere is one sided pain in jaw muscle due to sleeping on one side for 3-4 hours.which one is better heat or icing

    • admin says:

      Simply sleeping on your side should not cause pain in your jaw. I would get to your chiropractor and have it checked out, there is likely something else that is causing the pain.

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