Heat or Ice?

Oxygen - - Contents -

In­juries are com­mon, but the key is how you treat them. Here’s how to know when to choose ice vs. heat when the pain strikes.

have you ever got­ten in your car, reached for your seat belt and tweaked your neck? I have — and it’s ba­si­cally the lamest way ever to in­jure your­self. To make mat­ters worse, I tried to ig­nore my in­jury out of sheer em­bar­rass­ment. The pain and in­abil­ity to turn my head in ei­ther di­rec­tion likely would have been di­min­ished had I just put some ice on it. Or should that be heat? I can never re­mem­ber, so I chose nei­ther and suf­fered for nearly a week, us­ing a fic­ti­tious story about lift­ing too hard at the gym as my cover.

Whether you’ve pulled a mus­cle go­ing about your nor­mal ev­ery day ac­tiv­i­ties, tripped over a bar­bell and sprained your an­kle or have back pain that flares up seem­ingly out of nowhere, aches, pains and in­juries are com­mon. The key is how you treat them, which of­ten be­gins with an un­der­stand­ing of when to choose ice ver­sus heat the mo­ment pain strikes.

“Ice has an anti-in­flam­ma­tory ef­fect by de­creas­ing blood flow to an acutely in­jured area,” says Naresh Rao, DO, FAOASM, an os­teo­pathic sports medicine physi­cian who serves as the head physi­cian for the USA men’s wa­ter polo team and was on Team USA’s sports medicine team for the 2016 Sum­mer Olympics. “Ice is great for pain as­so­ci­ated with in­flam­ma­tion and works best if the in­jury is su­per­fi­cial enough to the skin so the cold can have an ef­fect. Con­versely, heat has a mus­cle-re­lax­ing ef­fect by in­creas­ing blood flow to a chron­i­cally in­jured area. Heat is great for stiff mus­cles and mus­cle spasms and can be used to help in­crease flex­i­bil­ity in stiff or arthritic joints.”

In his book Step Up Your Game: The Rev­o­lu­tion­ary Pro­gram Elite Ath­letes Use to In­crease Per­for­mance and Achieve To­tal Health (Sports Pub­lish­ing, 2016), Rao states that his rule of thumb for the first 24 to 48 hours af­ter an acute in­jury is to use ice for 20 min­utes on the hour along with some el­e­va­tion and com­pres­sion (like an elas­tic ban­dage). The ice is thought to re­duce in­flam­ma­tion that overly en­sues and re­duce pain.

“I rec­om­mend heat for more chronic mus­cu­lar ten­sion or mus­cle spasm,” he says. “Moist heat will ac­tu­ally help mus­cles re­lax. If you have a chron­i­cally tense up­per back, get­ting in the shower and us­ing hot wa­ter with the beat­ing ac­tion, like a massage, can be very ef­fec­tive.”

As for the school of thought that ad­vo­cates al­ter­nat­ing heat and cold (i.e., con­trast bath ther­apy), Rao says that while elite ath­letes fol­low this tech­nique, the re­search is not con­sis­tent in sup­port­ing its use.

“ICE HAS AN IN­FLAM­MA­TORY EF­FECT BY DE­CREAS­ING BLOOD FLOW TO AN ACUTELY IN­JURED AREA. HEAT HAS A MUS­CLE RE­LAX­ING EF­FECT BY IN­CREAS­ING BLOOD FLOW.”

BY JILL SCHILD­HOUSE

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