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The Great Ice vs. Heat Debate

There is soooo much confusion about this issue. It’s a shame because therapeutic icing and heating — cryotherapy and thermotherapy — are rational, cheap, easy, safe self-treatment options for many common painful problems. This article gives you a bird’s eye view of the issues, with links to other articles with as much detail as you could possibly want, especially the main icing article, the main heating article, and the please-beware-of-icing-back-pain article.

What ice and heat are for
Ice is for fresh injuries, and heat is for stiff, aching muscles. Roughly. But the devil is in the details, and there are a lot of them.
Hasn’t icing been myth-busted? It’s been fashionable lately to debunk icing. The backlash against icing has some merit, and I love to see myths busted of course, but I think in this case it’s mostly a non-issue. The majority of icing is done for minor pain control, and there’s really no problem with that.
Ice is for injuries — calming down damaged superficial tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process … that also happens to be incredibly painful and more biologically stubborn than it needs to be. Icing is mostly just a mild, drugless way of dulling the pain of inflammation and taking swelling down a bit… we hope. Examples: a freshly pulled muscle or a new case of IT band syndrome (which is more likely to respond than the other kind of runner’s knee, patellofemoral pain, because ITBS is superficial and PFPS is often a problem with deeper tissues).

 

Heat is for muscles, chronic pain, and stress — taking the edge off symptoms like muscle aching and stiffness, which have many unclear causes, but trigger points are probably one of the usual suspects. Chronic pain, especially back pain, often involves lots of tension, anxiety, hypervigilance, and sensitization, and comfortable heat can soothe a jangled mind and nervous system. Stress and fear are major factors in many painful problems, of course.

Alternating between applications of ice and heat is called contrasting therapy. It’s extremely stimulating and is mostly used to facilitate injury recovery, with unknown efficacy.

What ice and heat are not for

Both ice and heat have the potential to do some minor, temporary harm when used poorly. Heat can make inflammation significantly worse. Ice can aggravate symptoms of tightness and stiffness; it can also just make any pain worse when it’s unwanted.
Both ice and heat are pointless or worse when unwanted: icing when you’re already shivering, or heating when you’re already sweating. The brain may interpret an excess of either one as a threat, but icing is more threatening — and when brains think there’s a threat, they may also amp up the pain. Ice seems to be feel more threatening to most people.
If you add heat to a fresh injury, watch out: it’s going to get worse!
Be especially wary of icing muscle pain — and it may not be obvious. You may think your back is injured, for instance, but it may “just” be muscle pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain — the very conditions people often try to treat with ice.
Heat and inflammation are the other particularly bad combination. If you add heat to a 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.

What about injured muscle? Muscle strains?

If you’re supposed to ice injuries, but not muscle pain, then 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 usually involves obvious trauma during intense effort, causing severe pain suddenly. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat.

Is ice better than heat? Is heat better than ice?

Ideal uses of ice and heat are roughly equal in potency — which isn’t very potent. Neither is strong medicine. Some experiments have shown that both have only mild benefits, and those benefits are roughly equal in treating back pain. The reason to use them is not that they are highly effective treatments — they rarely are — but because they are so cheap, easy, and mostly safe, especially compared to many other popular treatments.

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.

 

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