Cool it Off or Heat it Up ?

One of the biggest questions we get after an injury is “should I put heat or ice on this?” It seems so simple, but it is one of the most controversial questions in injury medicine.

Let’s talk….

There have been many studies done on the efficacy of heat or ice on joint, muscle or soft tissue injuries and there is actually very little solid evidence to steer you toward  one or the other. Basically we have to go on experience and past results, and a little bit of common sense.

ICE

For acute injuries such as contusions, torn muscles, and fractures, use ice.  It decreases the inflammation and reduces the pain signals.

Wrap an ice pack, a pack a frozen peas or corn, or even frozen towels so the ice is not directly on the skin.

Only use ice packs for 10-20 minutes at a time to prevent frostbite.

Rest during a period of icing and if you are icing an extremity, elevate it.

Avoid ice if you have Reynaud’s disease, loss of sensation to the area, or paralysis.

Heat

For chronic injuries such as low back pain and stiffness, use heat.  It helps dilate the blood vessels, delivering more nutrients to the sore and stiff area.  It also stretches the softer tissues, including muscles, ligaments and tendons, easing stiffness.

Heat can be a hot water bottle, a microwave pack, a warm bath, or a sauna.

Heat packs should also be wrapped to prevent any burning of the skin and should not be kept on longer than 20 minutes.

Though heat can be a comfort, it should not be used on postoperative incisions or for acute injuries. Lengthy stays in a sauna or hot tub can cause weakness and dizziness. This could cause a fall that would result in more injuries.

The biggest thing to take from this is to not use heat on acute injuries or exacerbations. It will only increase any swelling, and along with that, the pain.

Citations

  • Schwitzguebel AJ, Muff G, Naets E, Karatzios C, Saubade M, Gremeaux V. [The acute management of muscle injuries in 2018]. Rev Med Suisse. 2018 Jul 11;14(613):1332-1339. PubMed PMID: 29998635