Ice vs Heat... When Should You Use Them for Pain Relief?

There has been a lot of controversy in the sports medicine world about using ice and heat as therapeutic modalities to treat pain. Ice in particular has been studied and researchers are now hypothesizing that using ice for an acute injury may actually be slowing down the healing process instead of speeding it up! Many athletes choose to use heat to help with pain relief as well, but which is really better to use? Ice or heat? And when?

First off, we need to look into the body’s response to pain and what is happening at a cellular level. Without going into the crazy specific details, when the body experiences injury, it first sends a pain response to the brain to basically “shut down” that area of the body. While that is happening, damaged cells are releasing “little pac men” as I like to call them. These pac men are now going around and trying to clean up all of the cellular debris from the damaged tissue. This process is known as the inflammatory response. The inflammatory response is not a bad thing like most people tend to think! This response is the swelling you see visually from the outside of the body.

Typically at this stage, we are conditioned to think we need to immediately put ice on the swelling. Although this is true, the reasoning of why we do it is different than what most people believe to be true. Ice has the ability to decrease our perception to pain because it “numbs it”. One point given to ice! However, ice cannot truly lower swelling because of the depth of tissue the cold needs to reach through to make a difference at the lymphatic level. The best (and only) ways to reduce swelling is through elevation and movement. Keeping your ankle above your heart (like honestly up high, not just on one pillow!), will allow gravity to help move the swelling back towards the heart. Likewise, riding a stationary bike or even something as simple as ankle rotations or towel slides to bend the knee, will help get the swelling moving out of the injured tissue. Better yet, elevate and create movement to really target the swelling! By reducing swelling, this in turn will help to reduce pain. So what does ice really do? It helps make things feel better, which is great! The downfall is it will only help for so long until the tissue warms back up. This is where corrective therapy really comes into play to allow for proper healing and a quality recovery from injury.

Now on to heat… we all know heat just feels good right? Laying on a heating pad or going in a hot whirlpool makes the muscles feel looser. Is that actually what is happening? Let’s talk about it!

Like ice, heat has the ability to change our perception to pain. Most people are told that heat is better for chronic injuries or injuries that are not acute (meaning they are not new). This statement is correct as well. Putting heat on an injury that just occurred and is swollen will definitely make it worse. Usually you want to avoid heat for the first 2-3 days (the inflammatory response is in full swing!). Heat can “relax” the muscle so to speak, which makes that awful tight feeling go away. But what happens when the heat is removed and the tissue cools back down? You guessed it… pain comes right back! So this again is where movement is going to be the best option. What better way to heat the body than getting the blood moving?! Corrective therapy can involve stretching to increase mobility which in turn will help those tight muscles not be so tight all of the time. Pain relief for a longer period of time? Score!

So what is all of this telling us? For an injury that is not acute, you can use ice or heat to relieve pain. It really comes down to patient preference and which seems to eliminate pain more for that individual. Just remember that ice and heat are modalities to AID in pain relief, not a method to FIX an injury. It is best to utilize corrective therapy in combination with ice or heat so you can have long lasting pain relief and potentially reduce injuries down the road!