Everybody experiences pain at one time or another. Whether the pain is caused by a new injury or a nagging old one, the bottom line is we want to feel better and to get out of pain as quickly as possible. Thermal modalities (such as ice & heat) are time-tested solutions to getting rid of pain. But how do you know if you should be using ice or heat? I routinely get asked about which one is better to use - and when. Unfortunately, many people inadvertently create more problems for themselves by using the wrong thermal modality at the wrong time. The key to correctly choosing ice or heat depends on the situation.
Consider the following problems:
• You've got a nagging old football injury
• One day ago, you fell down a flight of stairs and injured your ribs and your right hip
• Two months ago you were in a car accident which left you with ongoing neck pain
• You twisted your ankle a week ago while skiing
• Your child got hit in the head by a baseball during a game
What do you do about these problems? How do you correctly select the right thermal modality (ice vs. heat)? Which one do you select, and how frequently do you apply the therapy?
The first thing you need to consider is how long ago the injury occurred. Recent injuries are ones which occurred within the past twenty-four to thirty-six hours. For recent (or acute) injuries, you want to use ice. The reason for this is because after a traumatic event, the body goes through a healing process involving a number of sequential phases. These are: (1) the inflammatory phase, (2) the proliferative phase and (3) the remodeling phase.
During the inflammatory phase, the capillary beds open up to allow more blood flow to the injured region. This is often accompanied by redness (rubor), an increase in temperature (calor), pain (dolor) and swelling (tumor). These events are important, not only to protect the injured area, but also to ensure proper healing takes place. However, while the inflammatory process is important, it is possible (and desirable) to accelerate the healing process without jeopardizing anything by altering the blood flow to the injury site. We have the ability to modulate this process by way of the careful application of ice. Ice is a natural anti-inflammatory. It reduces pain & swelling and without any adverse effects to the liver or kidneys (as what you may get by taking drugs). Ice works by closing capillary blood flow, reducing swelling and edema and numbing the affected region.
I use ice for fifteen minutes followed by a one hour interval before re-applying the ice again. Why take it off for an hour? You must allow the tissues to sufficiently warm up before using ice again so you don't get a frost bite or freezer burn (resulting in damage to the skin & connective tissue).
Once the inflammatory phase has completed, the body transitions to the proliferative phase. This is when the body starts to try to patch the injured area by laying down connective tissue and scar tissue. At this point, we want to encourage this process as much as possible by opening blood flow to the affected region. Heat facilitates the capillary bed perfusion. Heat also soothes and relaxes muscles, allows for fuller pain-free range of motion and additionally, it feels great. Heat is also appropriate for use during the remodeling phase (the final phase of tissue repair).
For older (chronic) problems, you will generally want to use heat as the preferred thermal modality. My rule of thumb when using heat is to apply it for approximately 15-20 minutes per session.
Another thing you can try for older chronic problems is to use ice-heat contrast. What is involved with contrast therapy is to use heat early on in the day (or before exercise). You would then use ice at the conclusion of exercise (or at the end of the day). Think about what you've always heard about exercise. You warm up before and cool down after. Using heat and ice facilitates this and gives you a more profound effect. Chiropractors, physical therapists and athletic trainers all use ice & heat to help their patients feel better, move better and heal faster. Using these modalities correctly will allow you to get out of pain and get back to doing your activities of daily living.
