Ice vs. Heat: The Great Debate
Often in my practice I get asked about using ice or heat to help with pain management and the healing process. When is ice preferred over heat? Is ice beneficial at all? How long should I use either modality for?
Unfortunately, you will get many different answers depending on who you talk to and that’s because the evidence does not have a completely definitive answer.
But before we can get into the ice vs. heat debate we need to discuss the elephant in the room: inflammation.
For so long, inflammation took on the title of the bad guy, something that at all costs must be eliminated to improve recovery and decrease pain and until recently that seemed like the right thing to do. Over the past 5-10 years, researchers have shown that perhaps our view on inflammation is skewed. A paper by Peake and Neubauer in 2017 demonstrated that in fact inflammation is essential to muscle repair and regeneration:
“Although inflammation has historically been viewed as detrimental for recovery from exercise, it is now generally accepted that inflammatory responses, if tightly regulated, are integral to muscle repair and regeneration.” (Peake & Neubauer, 2017)
How can this be? How can we switch from being so concerned about inflammation to accepting its presence in our body? Well the short answer is that we learned more about inflammation and the impact it has on the body. And that answer showed that the acute inflammation that occurs immediately following injury is an impressive cascade of reactions designed to equip the body to heal as efficiently and quickly as possible and shutting that process down only slows this down. But this only applies to acute injuries.
When we are dealing with a chronic injury there is more to it. Inflammation at this point has long overstayed its welcome. It’s that friend who lingers too long at your house when you are clearly struggling to keep your eyes open. You hope that they notice and leave, but unfortunately they don’t and stay way past their welcome. This “extended stay” can cause chronic pain, dysfunctional movement, and stress which in turn elevates our stress hormone, cortisol, further activating inflammation. You see where I’m going with this?
So, now that you have a brief understanding of inflammation let’s go back to the original question: when should we ice vs. use heat? The answer, unfortunately, still remains unclear and depends on multiple variables. However, we do know a few things:
Ice is preferred for acute injuries (like sprains, strains, tendonitis flare-ups) in the first 24-72 hours especially where swelling is involved. Swelling can cause muscle inhibition and increase recovery time so if there is swelling then ice and elevation are beneficial for the first few days.
Heat, in contrast, is preferred for chronic injuries to decrease pain and improve mobility. Using heat before a physical therapy session can help ease pain and increase tolerance to beneficial exercises to help get you out of the pain cycle. Used alone, however, heat is transient but still beneficial for short term pain relief.
Icing should be limited to 10-15 minutes to prevent tissue damage. It’s also advisable to wait until the tissue fully warms up before icing again or doing any activity as reflex activity and motor function are impaired for about 30-minutes following.
Heating can be used for a bit longer, capping out at about 20-30 minutes for maximal benefit. There does not appear to be much added benefit to heat past 30 minutes.
So for now, give these recommendations a try or better yet, come and visit us at One Boulder Fitness for a specialized exercise program and specific education on which modality, if any, is appropriate for you!
**The above is focused on the use of ice and heat packs solely. In the future, we will discuss the benefits (or detriments) of other heat and cold therapy such as hot yoga, ice baths, sauna, and more!
