Hot and Cold

For most of my childhood and all of my adolescence, I was a figure skater. I could do jumps and spins, specific routines and all sorts of fancy tricks. But every successful jump came after dozens of failed attempts. One misstep in the footwork and I might find myself on the ground.

Falling came with the territory. It happened to all of us. But if one of the skaters took a particularly rough fall, they’d just head over to the bleachers and grab some spare ice to nurse their new bruise.

That was my first (and second, third, etc) experience with acute injuries. Ice was the best solution, and at the skating rink, it was the only solution. So when I later learned that a large portion of people don’t know to use ice for such injuries, or, worse yet, use heat, I was astonished.

But I really shouldn’t have been. After all, heat feels good. It can be quite relaxing and relieving – much more so than ice. Unfortunately, heat is usually not the right answer.

This was all nicely summed up by one of my teachers at massage school: You can almost never go wrong with ice, but you can almost always go wrong with heat. But why is that?

Well, when an injury occurs, the first way the body reacts is through inflammation. Blood and fluid move to the area, making it swollen, red, warm and tender…

But we should back up for just a moment and talk about what heat and ice do to the body. Applying ice will initially send the blood away from the area. That’s why the skin turns white – no more blood around to keep it pink. But after you remove the ice, all the blood comes rushing back to the area, and this increase in blood flow means more oxygen gets delivered to the muscles (similar to the body’s reaction during trigger point massage).

Putting heat on an area, on the other hand, will immediately cause all the blood to move towards the warmth (which is why the skin turns red). The blood flow doesn’t increase; instead, the blood just gathers in that area.

Back to the acute injury scenario. An excess of blood is already in the injured area due to inflammation, so adding heat won’t do anything new. In fact, applying heat will pool the blood and further the inflammation – pretty much the opposite of what’s intended. Ice, however, will decrease the inflammation and increase the blood flow – two key parts of the healing process.

When to use ice:

  • Acute trauma or injury
  • Chronic pain
  • Muscle spasm
  • Muscle soreness
  • Inflammation

Don’t use ice on areas that are already numb or over-sensitive (from disorders like diabetes or fibromyalgia) or on someone who has an insufficient circulatory system.

Ice will also cause the skin to go through a series of sensations, easily remembered as CBAN (cold, burn, ache, numb). Once the area becomes numb (after about 20 minutes), remove the ice and let the area warm up again before reapplying.

And while heat may not be a good option for injuries, it can still be beneficial in many scenarios.

When to use heat:

  • Muscle tightness
  • Muscle soreness
  • Muscle spasms
  • Menstrual pain

Don’t used heat for spinal cord injuries, MS, rheumatoid diseases or anything in which increased inflammation would be a problem. Use caution with products that create high heat (such as hydrocollator packs) – always use a cover (don’t put the hot object directly on the skin), and check the skin often for burns. Heat should be used in smaller increments than ice, 10 minutes maximum.

This may seem like a lot to keep track of, but you’ll notice that there’s a lot of overlap. Most of the times you can use heat, ice would also be appropriate. Heat is good for loosening up tight muscles, but if the muscle are tight and painful, ice is the best course of action.

The moral of the story is simple: When in doubt, use ice.

This entry was posted in Healing, Sports Injuries. Bookmark the permalink. Follow any comments here with the RSS feed for this post. Post a comment or leave a trackback.

Leave a Reply