Ice or Heat - "Which Should I Apply?"

Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Leslie J. Schoenfield, MD, PhD

Applying cold or heat for conditions involving the muscles or joints has been used for centuries. These temperature applications have been available without a prescription since early man ventured up and over snow-capped mountains and slipped down into soothing natural hot springs. Cold/ice and heat applications are also used today as standard medical treatments throughout the world. However, since they are obviously opposites, when are they best used? And when could they cause problems rather than be helpful?

This article will focus on the use of cold or heat applications for musculoskeletal conditions. It does not address the treatment of other conditions, such as burns or infections.


What happens to the tissues after an injury?

When a runner "pulls a groin" or a tennis player "strains a tendon," the soft tissues in the area of pain are injured. Immediately after the injury, there are disrupted fibers of the affected muscle, tendon, and/or ligament. Additionally, the tiny blood vessels (capillaries) that normally supply blood and oxygen to these tissues are broken. The broken capillaries then leak varying amounts of blood and serum into the adjacent tissues. Therefore, soon after a soft tissue injury, localized swelling occurs. The injured tissues become painful and tender, both directly from the trauma to them and indirectly from the subsequent swelling. This leads to the stiffness, pain, and tenderness that so often accompany the inflammation of tendinitis, bursitis, as well as strain and sprain injuries. It should also be noted that even a bone injury (such as a fracture) is typically accompanied by injury to the nearby soft tissues.

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