Ice or Heat?

Spring thaw near Fish Creek - April 2021

Ice or Heat?
You hurt your shoulder playing tennis or pickleball, your lower back aches from a long season of snow-shoveling, you twisted your ankle running after your grandkid. Should you hit the jacuzzi or grab your ice pack?

Generally, acute injuries (those that occur suddenly and often cause severe pain) should be treated with ice in the first 72 hours in order to reduce pain and inflammation. Chronic pain is often relieved by the use of heat - ideally moist heat - to reduce the stiffness. When recovering from acute injury, once the inflammation is significantly reduced, contrast therapy (ice:heat:ice) can be helpful to encourage healing.

How does ice work?
Ice constricts blood vessels and numbs nerves. In the initial stage of an injury, the body’s inflammatory response sends chemicals to the site. By reducing blood flow we slow that response and reduce the swelling. The numbing of the nerves reduces pain. 
Methods of icing include: cold packs, frozen bags of veggies, ice massage (using an ice cube directly on the injury), and frozen dixie cup (same as ice massage but you peel down the dixie cup from the frozen water inside). For lower limb or hand/wrist injuries, my favorite method is to submerge the injured part in a bucket or pot of ice water, completely immersing the tissues. 
With icing there are four stages of sensation, known as CBAN: Cold, Burning, Aching, Numbing. As soon as you feel the numbing, remove the ice to prevent damaging the tissues. Length of time varies - it is individual to the person and the method. 
Keep in mind that icing for acute injuries works well with consistency over time. For example, aim for 20 minutes (this may involve off and on again with the ice), 2 - 3 x per day for 5 days.

How does heat work?
Heat encourages circulation, blood flow that brings fresh oxygen and nutrients, and carries away waste products. Heat eases stiffness and allows for more fluid movement. 
Moist heat is best for the tissues as it penetrates more deeply than dry heat. 
Methods include hot showers, baths, jacuzzis, and heat packs that are warmed in the microwave. You can even wet a towel, wring it out, and microwave the towel. 
Time again will vary according to the person and the method, and consistency over time is a factor in success.

What is contrast therapy?
Once an injury has moved beyond the acute inflammation stage, contrast therapy can bump up the healing process. 
You always start and finish with ice, and use a time ratio of 1:2:1. For example, ice for 5 minutes, heat for 10 minutes, ice for 5 minutes. 
You can repeat several cycles, the main thing is to always start and finish with ice.

How does contrast therapy work?
When you apply the ice you are constricting the blood vessels. When you then apply the heat, the blood vessels dilate so there is increased blood flow to the area, and when you follow with the ice you are constricting once again, to continue to reduce inflammation and pain. It is like turning a hose on and off, creating a pump to get things moving in and out; that blood flow is bringing fresh nutrients and taking away waste products from the tissues. 
You can read more in this article: Cleveland Clinic How to Choose Between Ice and Heat.

The study linked below compared three different treatment groups for relief from low back pain. One group applied heat with naproxen, another ice with naproxen, and the third group used just naproxen alone. The researchers checked in with subjects four times over two weeks. The pain was most reduced with the heat and naproxen group, closely followed by those applying ice with naproxen. The conclusion was that hydrotherapy played a significant role in pain reduction. All groups had a decrease in pain over the two weeks. The study noted that a key factor was the consistency of the application of the thermotherapy or cryotherapy over time. 
Study: The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain

Originally published Feb 2023