Ice or Heat? This is a common question with a complicated answer.
I taught at Creighton University for 20 years. Before my students asked almost any question, they already knew the answer I would give them. It became a running joke. The answer to almost every question about how to treat an injury or a diagnosis is…
…it depends.
A good healthcare practitioner (Western or Eastern medicine) knows they are not treating a diagnosis or an injury. They are treating a person. We are all very similar, but we are all extremely different. There are no clear answers. There is good, solid research out there for many issues we face, but what we have is a drop in the bucket. The answers often change as new knowledge emerges.
Ice or Heat Backstory
Dr. Gabe Mirkin coined R.I.C.E. in 1978. This stands for rest, ice, compression, and elevation. It has been a commonly accepted practice for treating injuries, but there has never been much evidence to support it. This has also led to many common misconceptions about what to do for all types of pain.
In this short article, Dr. Mirkin discusses how icing or cooling actually delays recovery. Our natural response to injury is inflammation, which is a natural part of the healing process. Icing constricts blood vessels and prevents healing. However, he does say that icing may help prevent pain, but we should only do it for short ten-minute periods immediately following an injury.
The Cochran Library provides a systematic review of heat and cold for low back pain. There is moderate evidence for heat and very little evidence for cold.
Healing Through Movement
What about the “R” or the rest of the R.I.C.E. protocol? The NIH provides a fact sheet on low back pain. There is strong evidence that you should not stop moving. You should move gently within a safe range of motion, respecting your body’s pain limits. This movement pumps the muscles, pulling healing blood deep into the tissues. This pumping also mobilizes the lymph, which is critical for healing. If you are unsure how much you should move based on your injury, talk to your healthcare practitioner.
Other Ways to Deal with Pain
- Discuss your options with your healthcare provider. There may be other variables you should consider when deciding how to treat your pain. For example, if you have a condition that decreases your ability to feel, it may not be safe to use either heat or cold.
- The evidence points to heat if you are not experiencing an acute injury. But heat doesn’t mean hot. Gentle warmth is best. I prefer heating pads that can be warmed in the microwave. The temperature is easier to control, and you don’t risk falling asleep with an electronic device.
- Everyone is different. Even though the evidence might point to heat, if you are in pain and ice enables you to decrease your pain enough to move and complete your daily tasks, ice may be the better option for you. Life keeps on going despite our pain, but use ice sparingly. Remember that cold decreases your ability to feel, so move cautiously after using cold.
- If your goal is to move or stretch your muscles and fascia, the evidence points to warmth.
- You can do both. Alternate heat and cold.
- Remember that both should be used with caution. Don’t put either directly on the skin. Place a layer between the modality and your skin, such as a bath towel.
- The American Chronic Pain Association provides a Resource Guide addressing many options, including heat and cold.