Ice or Heat or Heat or Ice? (Win some free stuff)

Eventually we all get aches and pains. Do you know what to do about them until you have a chance to get in to your chiropractor? One question I’m often asked is about when to use ice or heat. This post has some basic guidelines for using these effective methods of pain control.

The use of heat/cold as a therapy is one of the oldest treatment methods known to man. This is because it is generally safe, effective and widely available.  Sometimes people even use heat and ice in contrast to move fluids throughout the body.  This is called hydrotherapy.

Cold therapies are really effective for any type of inflammatory condition.  You can tell if a tissue is inflamed because it may be swollen, hot, painful, red, or limited in range of motion.  If a tissue is inflamed you may have all or some of these symptoms.  Cold therapies such as ice are effective for controlling swelling and decreasing pain.  It’s the treatment of choice for any acute (within the first 0-48 hrs) injury to the muscles, skin or joints.

When you use cold therapies you will go through a series of sensations.  COBAN is an acronym that will help you remember what these sensations are.  COld, Burning, Analgesia (pain relief), Numbness.  Each stage lasts only a few minutes.  If using ice is uncomfortable, after a few minutes you will get to the point of analgesia and numbness where it should be more comfortable.  In order for ice to be effective you generally need to use it for at least 10 minutes.  Anything less than this will not get the tissues cool enough to have any physiological effects on swelling and inflammation.  I usually recommend that if you are going to use ice to leave it on for 20 minutes and then off for 60 minutes.

Heat should generally be avoided in the acute stage.  This is because it will accelerate the inflammation process and could cause more heat, swelling, and tissue damage.  After that first 48 hours it is safe to switch to heat or just throw it into the mix.  Heat draws fluid to an area by causing blood vessels and lymphatic channels to open up.  It also causes muscle tissue to relax and has a sedative effect.  Heat can be really effective for joint conditions such as rheumatoid arthritis where joint capsules are painful.

There are a few precautions for using heat or ice.  Make sure that the sensation in the area you are going to treat is intact.  If there is any numbness, tingling, pins-and-needles, etc. you should consult a healthcare professional before using either of these methods.  If you have altered sensation you may not be able to tell if you are getting too hot or cold and tissue could be damaged leading to serious complications.  Also avoid using heat or ice over open wounds, sores, or areas you think may be infected.

When someone is going to alternate heat and ice, sometimes there is a question of which you use to start or finish.  There are different theories on how to do this but research has shown that there is really no difference.

If you are using an instant chemical cold pack (the kind in first aid kits) you should never reuse them.  They can become extremely cold if refrozen and cause frostbite.  If you have an electric heating pad and plan to lay on top of it, you should keep the settings at or below medium.  If you plan on laying on top of any heating source be aware that if you fall asleep you may get burned.

Now would be a really good point in the post to use a great pun like: Follow this advice and you won’t get left out in the cold or I hope you warm up to this information and use it wisely.  What I’d rather do is have a contest.  So come up with something particularly “punny”.  It can be witty, cheesy or clever.  Post it in the comments and then we will vote for a winner.  I will send you a prize of a reusable cold pack and a box of Thermacare (TM) instant heat packs.

ThermaCare Heatwraps Pain Relief, Back & Hip, 2ct

Good Luck!

This Post Has 3 Comments

  1. Todd Washington

    Jason, that was some pretty “cool” advice you gave. Not bad from such a “hot” Chiropractor! I did not just say that!

    Seriously, this is good information and I am glad you are sharing it. I tell my 1st Aid classes to do a 20-on 40-off (minutes) when using ice therapy. I also give them a home recipe for ice packs. 1 part rubbing alcohol and 2 parts water, mix this and put in a sealable bag. The alcohol prevents it from frezzing solid and the water turns to slush so you can form fit it to the area needing therapy. Totally re-uasable and very inexpensive. Pretty “cool” huh?

  2. Jason Young, DC

    I’ve taken Todd’s CPR class and the man has “ice water” in his veins. The other nice thing about your cold pack recipe is that the alcohol, aside from preventing freezing, will keep the ice colder for longer at room temp. “HOT” tip Todd!

  3. Sarah


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