Should I Use Ice or Heat for Pain?

Heat applied to an ankle

Should you use heat or ice on your painful injury? The best method of solving this important riddle is to assess the nature and source of the pain. Essentially, a new injury, that is, one that you sustained within the last 48 hours, is best treated with ice. Chronic pain, or pain that you have had for a long time, is generally best treated with moist heat. Understanding the mechanisms of injury and the physiological and biochemical causes of pain helps us to differentiate the indications for applying ice or applying moist heat.

The primary rule is that you can never go wrong with applying ice. Ice calms things down and, although an ice application may be uncomfortably cold for a few moments, the overall effect is soothing. Cold decreases local metabolism and constricts small blood vessels (arterioles). Cold reduces nerve conduction velocity, that is, the speed at which nerve impulses are transmitted, and therefore reduces the number of pain signals that reach your brain per unit time. Thus, ice applications provide vasoconstriction, analgesia, and sedation. Ice is indicated for acute musculoskeletal injury, burns, insect bites, bleeding, and snake bites. Ice should not be used for gout, rheumatoid arthritis, Raynaud's phenomenon, history of vascular impairment, and cold allergies. As well, ice should not be used for a patient in a coma.

Moist heat increases local metabolism and dilates small blood vessels. Vasodilation results in increased nutrition, increased activity of white blood cells (phagocytosis), and increased removal of waste (metabolic end-products and damaged cellular structures). Moist heat provides analgesia, sedation, and reduces muscle spasms. Heat is best for chronic pain and muscle spasms. Contraindications to moist heat include acute musculoskeletal injury, area of diminished sensation, acute skin conditions, pregnancy, malignancy, diabetes, encapsulated swelling, hemorrhagic disorders, and suppurative conditions.

Generally, ice applications are used for acute injuries within a 72-hour time frame from the onset of the injury. Acute injury damages local capillaries, causing blood to leak into the spaces between cells and tissues, where it doesn't belong. Such uncontained blood causes pressure on local nerve endings, creating pain. Also, pressure is applied to nearby cells, causing extended injury and possibly cell death. Thus, limiting the amount of blood leaking out of disrupted capillaries is critical in slowing the effects and reducing the impact of musculoskeletal injury. Ice performs this function. Ice reduces swelling, reduces pain, and provides a sedative effect.

When applying ice, it's very important to avoid damaging the skin. Ice packs should always be wrapped in a towel. Ice should rarely be applied directly to the skin. Duration and frequency of ice applications is not an exact science, but a useful guideline is to apply ice for 15 minutes every two hours for a moderately acute injury, using three to four ice applications per day. However, you will know instinctively when the time is right to apply the next ice pack.

Moist heat applications follow similar guidelines. Dry heat should never be used. Moist heat packs should be wrapped in a towel and are applied for 15 minutes every two to three hours, up to several applications per day.

Recovering from injury requires your body to put forth a great deal of effort and requires support from the nerve system, the body's master system. Regular chiropractic care provides great assistance in the process of recovery from an injury. By detecting and correcting spinal misalignments and sources of nerve interference, regular chiropractic care helps ensure optimal functioning of the nerve system. Thus, regular chiropractic care helps facilitate your recovery and helps you return to your full range of activities as quickly as possible.

1McCarberg B, D'Arcy Y: Options in topical therapies in the management of patients with acute pain. Postgrad Med 125(4 Suppl 1):19-24, 2013

2Piana LE, et al: The Cold, Hard Facts of Cryotherapy in Orthopedics. Am J Orthop (Belle Mead NJ) 2018 Sep;47(9). doi: 10.12788/ajo.2018.0075

3Mayer JM, Mooney V: Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil 87(10):1310-1317, 2006

Location

Find us on the map

Office Hours

Monday:

Closed

Tuesday:

8:00 am-12:00 pm

2:30 pm-7:00 pm

Wednesday:

Closed

Thursday:

8:00 am-12:00 pm

2:30 pm-7:00 pm

Friday:

Closed

Saturday:

8:00 am-11:00 am

Sunday:

Closed

  • "I have suffered from severe back pain and migraines. The treatment has been very helpful and Dr Waisbrots adjustment are very gentle. He also treats my children. 2 of my children have had chiari decompression surgery and he has helped them tremendously."
    ★★★★★ Kim / Google+
  • "I feel very confident in the care Dr. Paul gives because of his wealth of knowledge related to the body, science and healing! Leah is the office manager and is very organized and quick to answer any questions about appointments and billing. Michelle provides professional therapy. All 3, along with the massage therapists, work together harmoniously providing an overall great experience."
    ★★★★★ Nancy / Facebook
  • "Doctor Paul continues to keep me on my feet. I stand, run, and coach all day, then typically toss a couple more hours in after school. His skills are awesome and his personality is engaging and pleasant. My wife and two kids both get proactive treatment as well and are very healthy."
    ★★★★★ Casey / Google +
  • "From fixing my frozen shoulder to keeping me active, Dr Paul and his wonderful staff have been there for me. I see them every two weeks now to maintain my good health."
    ★★★★★ Barb / Google+
  • "Awesome office. Wonderful doctor and Staff!"
    ★★★★★ Leah / Google +
  • "I have attended the clinic many times since the start of 2014. Doc was thorough in his examination and took lots of time to explaine everything to me. He is an excellent practitioner and is always positive and upbeat. His support staff operate like a fine-tuned machine and are cheerful and competent. I highly recommend this clinic."
    ★★★★★ Michael / Google+
  • "Amazing staff, friendly, clean and extremely knowledgeable. A++"
    ★★★★★ James / Google +
  • "Dr. Paul allows me to stay in great shape because I run, lift, and do so many plyometrics my core takes a beating. He fixes me up every time!"
    ★★★★★ Connor / Yellowpages.com
  • "I cannot praise Dr. Waisbrot and staff at Baker Chiro enough. I have been going to Dr. Waisbrot for five years and have had great success. I am a cyclist and have injured my back several times within that time and without fail, they have helped me get back to riding all without medicine, and in a very short time."
    ★★★★★ Bruce / Google+
  • "After two years of seeing three different doctors, having an MRI and several sets of xrays for my shoulder issue, Dr. Paul immediately diagnosed the root cause of the problem. I felt so much better the day after my very first visit. I have been raving about him to everyone I know. He also help my son with a knee problem. He has a wonderful personality as does his office staff. Highly recommend!"
    ★★★★★ RateMDs.com
  • "Dr. Paul is my guy. We bring the whole family in for superb treatment with a very engaging clinician and talented chiropractor."
    ★★★★★ Janel / Yelp
  • "I suffered for years with chronic lower back pain (L5,S1). Dr. Paul has given me new life! Absolutely, hands down, the most incredible chiropractor I've been to."
    ★★★★★ Bradley / Google+