Hot or Cold

People often ask me whether they should use ice or heat to tend a tender tendon or mend a misused muscle. I am asked which would be better and what the difference is. Here is some explanation and a few quick tips. Both ice and heat “gate” pain. Many pain treatments are based on this concept of “gating” which has been described by Melzack and Wall. This essentially means that both ice and heat can oftentimes provide a strong enough sensation to interfere with irritated nerves effectively at the level of the spinal chord before the pain information gets generated in your brain. Pain occurs, as all sensations do, in your brain. Ice and heat both gate pain but they have properties that make them unique and therefore appropriate for different situations. Ice decreases the conduction velocity of pain nerves, numbing the area, and therefore is an additional mechanism by which it provides relief. Ice is often applied immediately after an injury in the acute phase (first 48 hours), particularly if there is swelling or inflammation. Cold is also used for overuse or chronic injuries but typically after activity. If you have exercised or moved in a way that causes increased tissue wear or more aching, then it is usually ice that you want to apply right afterwards. On the other hand, heat stimulates greater blood flow to the injured tissue, helps loosen and relax muscles, and is typically used in the later phases of healing. After the acute phase, use heat to prepare for, and ice to recover from activity. You might apply heat in the morning to get chronically tight muscles more pliable and ice at the end of your day to control inflammation. Both treatments last between 12 and 20 minutes. If used properly, ice and heat promote healing. Please remember, it is most often important to seek an evaluation from your physician and/or physical therapist when you experience an injury.

By Anna Kotula, DPT