Ice or Heat - "Which Should I Apply?"
Medical Author: William C.
Shiel Jr., MD, FACP, FACR
Medical Editor: Leslie J. Schoenfield, MD, PhD
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.
So, what is best applied after
In a word, ICE.
The swelling and much of the
inflammation that follows an injury is largely due to the leakage of blood from
the ruptured capillaries. Therefore, cold applications with ice can help by
causing the blood vessels to constrict (clamp down). This constriction of the
blood vessels prevents further leakage of blood and serum and minimizes swelling
and pain. The cold from an ice pack application also has an added benefit of
providing pain relief.
In fact, the optimal management
of an acute injury can easily be remembered using the acronym, RICE:
Rest (minimize movement of the
injured body part)
Ice (apply a cold pack)
Compression (light pressure
wrap to the affected body part can help minimize leakage of blood and swelling)
Elevation (raise the body part
up so that the pressure from the blood and tissue swelling the affected area is
reduced as the fluids drain from the area by gravity)
How does ice help after an
injury and how might heat hurt?
As stated above, icing the
injured tissues helps by limiting the leakage of blood and serum from the
capillaries into the adjacent tissues. Ice also prevents swelling. In contrast,
heating tissues causes the capillaries to widen. This widening can cause an
increase in the leakage of blood from the capillaries and add to the swelling
and pain. It is important to note that the blood that leaks into the tissues
will later lead to inflammation, which slows the healing process.
What about recovery after the
The days after an injury, when
the tissues are healing, require a different approach from the immediate
treatment. Now, the blood leakage from the injured capillaries has generally
stopped because the capillaries have been naturally plugged by microscopic blood clots in the repair process. The blood that remains in the tissues needs to be
reabsorbed by the body. At this time, heat applications can help, especially
prior to recovery exercise workouts. The heat provides an additional benefit by
relaxing the muscles of the injured area so that the workouts can occur as
safely as possible. Frequently, immediately after a recovery workout, ice is
applied so that leakage of serum and/or blood from any capillaries that are
disrupted during the workout is minimized.
What is best with the
inflammation of arthritis?
I often recommend that my
patients use ice packs on the affected joint in order to minimize inflammation
and reduce pain, especially with a newly inflamed joint. This can be helpful for many forms of arthritis, including rheumatoid arthritis, gout, osteoarthritis, pseudogout, ankylosing spondylitis, and many others. It should be
remembered, however, that icing usually causes stiffness to the local tissues.
Accordingly, heat applications can sometimes work best early in the day by
relaxing the muscles around the joints, while ice applications at the end of the
day can minimize the inflammation resulting from the daily activities.