A common question we are asked is whether ice or heat should be used to manage pain. As with most things, the answer is that it depends. The length of time since the injury, type of tissue involved, and underlying conditions can all affect whether ice, heat, or neither are appropriate to managing pain and speeding recovery. Here is a brief explanation that should help guide your recovery.

Ice is a form of cryotherapy (cold therapy) which is cheap and easy to use. In the initial stages of healing after an injury, ice can be used to manage inflammation and decrease pain. The body’s natural response to an injury is to increase the size of the blood vessels in the area, increasing blood flow and bringing nutrients and specialized cells to the damaged tissue. This response produces swelling, heat, and pain. Although this inflammatory response is necessary to the healing process, we can use ice to control the swelling and reduce pain while the tissue heals. This helps prevent the body from creating a constant pain signal to the area which can persist after the tissue has healed and allows for more motion in the area. It is important to re-establish proper motion following an injury, so using ice and passive, pain free range of motion is key to recovery (Passive range of motion means moving the joint or tissue without using muscles to do it. An example is having someone else move your arm for you).

Ice is appropriate for injuries like acute (within the first 2 weeks) sprains, strains, and bruises, inflamed joints such as an irritated rib, and tendonitis. The easiest way to apply ice is to use cubed or crushed ice in a plastic bag, with a wet cloth or towel between your skin and the ice. Never apply ice directly to the skin without some sort of layer in between to avoid frostbite. Ice can be used every 2 hours at most, for a duration of 20 minutes or until the area becomes numb, whichever comes first. Be aware that people with certain conditions such as impaired circulation, poor sensation, or cold sensitivity should avoid using ice to treat an injury.

As you might imagine, heat has the opposite effect of cold when it comes to tissue response. While ice reduces swelling and inflammation, heat will increase blood-flow to the area and in turn can increase swelling. This is why heat is reserved for chronic injuries and should never be used on acute injuries. The chronic stage of tissue healing occurs about 2 weeks after the initial injury. Keys to recovery during this stage are increasing circulation and restoring normal range of motion. Heat will increase tissue metabolism and elasticity, allowing for faster recovery.

Heat application can be through a heat pack, warm bath, or shower, and we’re looking for ‘warm’ temperatures rather than 'hot.’ If using a heat pack, standard practice is to have 6 layers of a towel between you and the pack, and never lay on top of the heating pack. Treatment should last about 20-30 mins and should never reach the point of pain. Heat is a great way to combat muscle aches and stiffness, such as what many people experience after their first adjustment. Avoid the use of heat if you have diabetes, vascular or skin conditions, or MS.

Both ice and heat can be useful in managing pain and injuries. When in doubt always consult a healthcare provider to see what will work best for you. And as always, keep your spine straight and balanced in order to have the best injury recovery. Ice and heat may help manage pain and speed tissue healing, but they won’t fix a crooked spine!