Heat or Ice?
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.”