The Great Debate: Ice Vs. Heat

Following injury, many people choose to apply heat because heat feels good and they can use the heat for hours without any pain. But is heat the best treatment for injury? The answer is: Not exactly.

When ice is applied, the body experiences four stages of cold therapy. First, your body feels cold, followed by burning, then achiness, and finally numbness. Cold therapy, also known as cryotherapy, works on the principle of heat exchange: When you place a cooler object in direct contact with an object of warmer temperature - such as ice against skin - the cooler object will absorb the heat of the warmer object.

Why is heat exchange important in cryotherapy? Following an injury, the body responds with vasodilation (an expanding of blood vessels) and a rushing of blood to the area for protection. The injured area becomes swollen and inflamed and will remain this way until treated. This period is known as the acute inflammatory phase and can last one hour, one day, one week, or six weeks depending on what action has been taken to reduce or eliminate the blood that has pooled in the area.

During the acute inflammatory phase of recovery, examination findings include varying levels of pain, swelling, heat, and redness. The goal during this phase is to decrease these four symptoms as much as possible. Cryotherapy is the initial therapy of choice to decrease blood flow and control the resulting inflammation. Following an injury, applying the "RICE" principle is the best treatment: Rest, Ice, Compression, and Elevation.

We also need to be aware, however, that cryotherapy can potentially be counterproductive to the recovery process if not used properly. Keep ice on the injured area for no longer than 20 minutes, then wait at least 40 minutes before applying ice again. After 20 minutes, ice becomes much less effective and you risk damaging soft tissue; beyonhd 30 minutes, ice has the same physiological effect as heat and draws blood back into the area.

To recap, ice: 1) decreases blood flow and inflammation; 2) blocks pain by numbing; 3) should be used immediately after injury; and 4) should be used after activity which utilizes the injured area.

In contrast, heat: 1) increases blood flow and promoted healing; 2) decreases stiffness and increases elasticity of tissue; 3) relaxes muscles; and 4) can be used before activity for tight muscles.

Failure to timely prescribe the proper therapy can result in delayed recovery. When injuries are treated quickly and properly, the result is less time away from work, sports, and everyday activities.

--Bryan Haig, MSPT