One of the most common questions I get in the office is "Should I use ice or heat?" Typically, people are confused about which is better. This decision can be significantly helpful or hurtful, depending on the case.

For a new or acute injury "ice is nice," as it vasoconstricts and pushes out inflammation or swelling. This usually relieves pain and discomfort, even though the initial shock of ice on a cold winter day may not be too appealing to most of us. This is probably why most people will wrongly choose heat as their initial course of self-care. This is generally the wrong choice for a new injury because heat vasodilates, which draws blood into the injured area that is already inflamed and swollen, thus adding more fluid to the injured area. This is like throwing gas on a fire. Heat may feel good initially, but often soon after, increased pain intensity and frequency may occur.

For pain that is chronic, heat can be very helpful, because it relaxes muscles and improves movement by reducing stiffness (but never use heat more than 20 minutes per hour). Leaving heat on for too long can be dangerous, even causing burns with a heating pad left on for hours of continuous use.

When using ice, there are several ways you can apply it. If you only have 5-10 minutes, that is better than nothing. However, an ideal approach is to apply the ice pack as follows: Ice for 20 minutes, off 40 minutes, on 20 minutes, off 40 minutes, etc. for a total of three hours. The 40 minutes between icing helps the area to warm up by allowing the blood to come back into the injured area, which prevents frostbite and sets up a pump-like action to remove excess fluid from the area. Another good approach is called contrast therapy, where you alternate ice and heat as follows: Ice for 10 minutes, heat 5 minutes, Ice 10 minutes, heat 5 minutes, and ice 10 minutes for a total time of 40 minutes. This approach creates a stronger pump-like action that pushes out fluids/inflammation (with ice) followed by pulling in fluids (with heat). Both approaches are effective. If you ever feel worse after icing, please stop and contact your doctor, as you may have a unique case or situation.

The timely use of ice after an injury can be very effective for relieving pain and reducing inflammation.

For more information, contact Dr. Wendy at haydenhealth@gmail.com.