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The Great Ice vs. Heat Confusion Debacle

A quick guide that explains when to ice, when to heat, when not to, and why

650 words, published 2007, updated Oct 24th, 2013
by Paul Ingraham, Vancouver, Canada bio
I am a science writer, a former massage therapist, and the Assistant Editor of Science-Based Medicine since 2009. I am nearly done with a long-procrastinated Bachelor of Health Sciences degree. I am a middle-aged runner and ultimate player with plenty of personal experience with athletic injury and chronic pain. Readers often want to know more about me and my qualifications, because my style and subject matter is controversial. Most importantly, yes, I used to actually believe and practice almost everything that I now debunk and criticize. I live by the ocean with my wife in beautiful downtown Vancouver.

There is sooooo much confusion about this issue, and it’s a shame because icing and heating — cryotherapy and thermotherapy — are both worthwhile and inexpensive self-treatment options with minimal risks. This article gives you a concise, bird’s eye view of the issues, and links to other articles provide as much detail as you could possibly want.

What ice and heat are for

Ice is for injuries, and heat is for muscles.

Ice is for injuries — calming down damaged tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process … that also happens to be incredibly painful. Icing is mostly just a mild, drugless way of controlling the pain of inflammation.

Heat is for muscles — taking the edge off the pain of whole muscle spasms and trigger points (localized spasms, or muscle knots), and for easing psychological stress (which can be a major factor in many pain problems).

What ice and heat are not for

Heat can make inflammation worse, and ice can make muscle spasms worse, so they have the potential to do some mild harm when mixed up. And both are either pointless or harmful when unwanted: icing when you already feel shivering, or heating when your already sweating. The brain may interpret an excess of either one as a threat — and when brains think there’s a threat, they may also amp up the pain.

But heat and inflammation are a particularly bad combination. If you add heat to an fresh injury, watch out: it’s going to get worse! A physician once told my father to heat a freshly injured knee, and wow — it swelled up like a balloon, three times bigger than it had been before. And three times more painful. (That is a rare example of a particularly severe negative reaction to heat. Most cases are not going to be that bad!)

The lesser known threat is from icing at the wrong time, or when it’s unwanted.

If you ice painful muscles, watch out: it’s probably going to get worse! Ice can aggravate muscle spasms and trigger points, which are often present in low back and neck pain — the very condition people often try to treat with ice. Severe spasm and trigger points can be spectacularly painful, like knife wounds, and are easily mistaken for “iceable” injury and inflammation. But if you ice these tissues, woe is you — the muscles are likely to contract even harder, and the trigger points burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain. If in doubt, please see below in the “More information” section.

What about injured muscle?

If you’re supposed to ice injuries, but not muscles, what do you with injured muscles (a muscle tear or muscle strain)?

That can be a tough call, but ice usually wins — but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury almost always involves severe, sudden pain. If the muscle is truly torn, then use ice to bring down the inflammation. Once the worst is over, switch to heat.

Which is better?

Ice packs and heating pads are not especially powerful medicine: experiments have shown that both have only mild benefits, and those benefits are roughly equal.1

The bottom line

The bottom line is: use whatever feels best to you!

Your own preference is the tie-breaker and probably the most important consideration. For instance, heat cannot help if you already feel unpleasantly flushed and don’t want to be heated. And ice is unlikely to be effective if you have a chill and hate the idea of being iced!

If you start to use one and you don’t like the feel of it … just switch to the other.


More hot and cold information

About Paul Ingraham

I am a science writer, former massage therapist, and assistant editor of Science-Based Medicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.

Notes

  1. Garra et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Academic Emergency Medicine. 2010. PubMed #20536800.

    What’s better for neck and back pain — ice or heat? This experiment, conducted at a university-based emergency department, compared the effectiveness of these two common treatments. Everyone studied received 400mg of ibuprofen orally and then thirty patients were given a half hour of either a heating pad or a cold pack.

    The researchers concluded that adding heat or cold to ibuprofen therapy did not change the result. Both heat and cold resulted in “mild yet similar improvement in the pain severity.” They recommend that the “choice of heat or cold therapy should be based on patient and practitioner preferences and availability.”

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