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Ice? or Heat?

The question of the ages. "When should I use ice? When should I use heat?"

If this one were easily known, world peace would occur. I joke, but it is one of the most common questions I get. So here is the answer.

Ice is used when there is swelling or inflammation. Heat is used to relax muscles and for chronic issues.

So what does thatmean?


Inflammation occurs when there is a new injury that the body is actively repairing. (For the moment, let's ignore the complex issue from which many people now suffer, which is chronic inflammation. More on that in a later blog.) The inflammatory process causes there to be approximately a 48 hour window of activity in which your body is bringing chemicals to the area of injury to cushion the area, and your macrophages (the "garbage men" of your body) eat up the damaged tissue and remove it.

To be clear: If you have an area that is sore when you lightly press on it, use ice. If it looks puffy, use ice. If you try to press hard on it and it causes you to feel a ‘bad pain’, use ice. If it is reddish in color, use ice.

And here is the Queen Mother of all rules:

When in doubt, use ice.

There I said it.  When in doubt use ice.  You can’t go wrong with ice.

I should clarify that statement: Most people can't go wrong with ice. Some people have an 'allergy' to ice. I use the word 'allergy' lightly. It's more appropriate to call it a sensitivity.

When ice is applied, don’t use just ice in a zip lock with ice cubes in it and put it on raw skin. You may get an ice burn which doesn’t help the situation. Upgrade your equipment with  a gel pack that stays flexible when you freeze it. Some gel packs also have a felt covering, rather than plastic, which keeps the ice away from the skin.  Keep a frozen gel pack in the freezer at all times, and you are ready to go should silly things happen. Which they do.

If you are going to use a home-made ice pack, here is a few pointers. Put some water in a plastic  Ziplock® bag with a splash of rubbing alcohol. Put it in the freezer and it will make a slushy type of ice pack that better conforms to the contours of your body. Put 2 ice cubes in a glass with a splash of whisky to reduce pain from the inside. Just kidding.  When you put the slushy ice on your back, be sure you put a moist towel between you and it. This is important because, remember, putting ice directly on your skin can cause an ice burn.

Another idea is to take a bag of peas, wrap it in a moist towel and put it on your sore spot. The peas allow the ice to conform to the shape of your body. If your soreness is larger than the bag of peas, you will have to re-freeze the peas and re-apply them. Again, you may need to upgrade your equipment with a larger gel ice pack. And don't eat the peas after you have used them this way.

Ice should only be applied for 20 minutes. Only 20 minutes. If your injury makes you want to rest, which is a good thing, use a timer. Then apply the ice and lay down for a nap. Using ice for morethan 20 minutes will cause it to have the reverse action, and you may get more pain and swelling. So use it for only 20 minutes. Here’s why it’s 20 minutes: When you first apply ice, obviously it will feel cold. After about 5 minutes, it will feel tingly or even prickly painful. That will last 5 minutes. Then it may feel warm. After 5 minutes of that, it will feel numb. That’s the effect we are going for: numb. Leave it on for 5 minutes of numb and you are done. That equals 20 minutes.

As I said, some people have an allergy to ice. They apply ice as directed, but the cold of the ice goes straight to sharp pain and never progresses to numb. Usually these people are left feeling more pain and have a persistent redness where they put the ice. This is rare but does exist. To clarify, it doesn’t mean that you are allowed to be a whiner about ice being cold when you first put it on your skin. Of course it’s cold, it’s ice!  If used properly, you can fall in love.

How often? Ice can be used as often as every hour.  And remember, only 20 minutes at a time. When you have active inflammation, use it at least 3 times per day.

Evil Temptress alert!  Strangely when you need ice, heat can sometimes feel fantastic, in the moment. For example: a hot bath after a bad fall on a ski slope, heat on your neck after that minor fender bender, or the hot shower beating on your lower back after you helped a friend move an old refrigerator out of their basement. Notice I said, it feels good in the moment. Do not be tricked!  Do not use heat in any form when you should be using ice. Even the seat heater in your car can cause problems if there is active inflammation.

Moist heat

Notice that I said ‘moist’ heat. Why? Typically, we use heat to reduce muscle spasm. The moisture gets the heat into the muscle.  (You may use dry heat when  trying to warm your bones under an electric blanket on a cold February night in Indiana. That's completely acceptable.)

So, you ask, what is moist heat?  A general rule is something you put in the microwave. That can be a gel pack, or it can be a purchased fabric covered bean pack with aromatherapy in it. You can make your own if you put rice in a sock, you may have to put the rice in a plastic bag first, and tie it off with a rubber band and put it in the microwave. The moisture in the rice responds to heating in the microwave. Does your grandma have a hot water bottle?  Yes, that is moist heat as well.

If used on muscle spasm, moist heat will reduce the tightness and stiffness of a muscle, it will also reduce cramping or spasm in a muscle.

Restless leg syndrome can be helped by putting moist heat on your feet when you retire for the night. A tension headache can be alleviated by putting moist heat on the back of your head and upper neck.

A word of caution: if you are unsure if heat is the correct thing, do this: Use heat, moist heat, for 20 minutes. Then, wait 2 hours. If you feel the same or better, heat is fine to use. If you feel worse, do not use heat. Use ice. There may have been some underlying swelling that reacted poorly to the heat. Use ice.

"I’ve been using ice. When do I switch from ice to heat? Or, am I ready for heat?"

When you are ready for heat, celebrate. This is a graduation. You have emerged from the active inflammatory phase to a repair phase. When you can press on the area firmly and feel a ‘good pain’, you are probably ready for heat. You will be ready for this transition 2-14 days after an injury or flare-up. See the note above about testing heat first and then waiting 2 hours. Check in with how you feel. If all is well, you may continue with moist heat. See.. it's time to celebrate!


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