Which do I use, Ice or Heat?
By Kym Thomas, Medical Massage Practitioner


The application of ice or heat on an aching muscle depends on the stage of the injury.  All muscle pain is not created equal. Ice is best used on acute injuries (an injury that occurred up to 48 hours ago). Heat works well on chronic injuries (an injury that has been around for a long time and keeps reoccurring or an injury that is in the maturation stage, when mobility and strength is the focus).

Ice decreases pain directly, reduces swelling and inflammation, and perhaps most importantly, decreases metabolism of the cells so they don’t need more oxygen than is available.  The result is less tissue damage and a smaller area to be repaired.  Usually, there is less swelling; thereby repair can begin sooner. In order to benefit from ice, you must use it correctly. Avoid putting ice directly on the skin. First wrap the ice or ice pack in a heavy towel or plastic bag, then apply. Chill the injured area for 6 to 20 minutes, or until it gets numb (icing for more than 20 minutes may damage skin and nerves). Ice is contraindicated for someone with circulatory insufficiencies.

Heat decreases muscle spasms, which reduces pain. It also increases circulation of blood and brings new oxygen to the injured areas. It increases metabolism and vasodilation, all of which help in the healing process. To be used properly, heat should be applied to the aching muscles for 5 to 20 minutes. Moist heat is recommended over dry heat. Do not overheat, or leave on for extended periods, as burning of the tissue may occur. Heat is contraindicated for fever, infections, acute inflammatory conditions, cardiac and circulatory insufficiencies.

Ice and heat can also be used alternately to act as a pump for faster healing. Inflammation is reduced, then new oxygen is brought back in to heal. This is most effective for sub acute injuries, (after the first 48 hours). Begin by icing for 20 minutes, follow with 5 to 7 minutes of heat, and end with 20 more minutes of ice. Then gently move and stretch the area that is injured. Repeat hourly, if possible, or at least three times a day.

The next time your muscles are hurting use the appropriate form of ice, heat or both.

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