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Ouch! Should I use heat or ice?

March 20, 2015

Remember as a youngster placing ice cubes wrapped in a towel on a bump after you got hurt in order to bring the swelling down?

Some people may find ice uncomfortable and the warmth of heat to feel better on an injury, such as a muscle pull or a stiff back. But you may not be using the proper therapy when it comes to treating sprains, strains and other conditions, such as muscle contusions, arthritis, tendinitis or bursitis.

Cold v. Hot Therapy

“Cold is usually applied to new injuries, such as a bruise or sprain, to minimize inflammation and swelling by decreasing blood flow to the injured area. Heat is used for chronic pain and minor sore muscles and works by bringing more blood to the injured area to help in healing,” said Dr. Julio Martinez-Silvestrini, medical director of Outpatient Physical Medicine and Rehabilitation and Baystate Rehabilitation Care.

He noted cold therapy is usually applied in the first 48 to 72 hours after an acute injury or a recent flare-up of an old injury. After 72 hours, both cold and heat can be used for pain relief, greatly depending on one’s preference and other factors.

If there is still a lot of inflammation or joint swelling, usually cold is recommended. Common uses of cold treatments include shoulder or elbow pain after throwing a ball or an acute ankle sprain.

For those suffering from a sudden back injury, Dr. Martinez-Silvestrini said ice is recommended. However, if you experience a stiff back after riding a vehicle for two or three hours, for example, a heating pad or warm shower may help to loosen up those muscles. Regular crushed ice, gel ice packs, and even a frozen vegetable bag may be as effective.

Cold therapy is usually recommended for 20-30 minutes every 2-3 hours as needed. Heat therapy is also recommended for 20-30 minutes every 2-3 hours.

Dr. Martinez-Silvestrini cautioned those using an electrical heating pad, even ones designed with an automatic timer, to guard against possible skin burns. He recommends refraining from laying down on top of the heating pad, instead laying down first and then applying the heating pad on top of where you are feeling discomfort. The Baystate physician also warns against falling asleep with the heating pad on.

“Hot water bags and microwaveable cloth bags may be safer because they will cool down over time, but still may burn you if they are too hot when applied,” said Dr. Martinez-Silvestrini.

Other uses of hot or cold therapy include treating bug bites, headaches and arthritis, noted Dr. Martinez-Silvestrini. For bug bites, especially those that itch, use cold which can help reduce swelling. Migraine headaches are best treated with cold, while tension headaches respond best to heat applied to tight muscles in the neck or jaw. Arthritis pain is most commonly treated by applying moist heat to chronically stiff joints, which relaxes tight muscles resulting in less pain and greater flexibility. Ice can be applied in cases of known arthritis, if an acute flare or swelling occurs.

If an acute injury does not improve after a few days, or is getting worse, Dr. Martinez-Silvestrini recommends making an appointment to see your doctor. He said you should also see your doctor for a flare-up of an old injury if it has not resolved in 2-4 weeks or if new symptoms are present. Talk to your doctor if any injury, old or new, has associated muscle or joint deformity, progressive rash, swelling or redness. New numbness, tingling, weakness, sensation loss, fever, chills, progressive weight loss or uncontrolled nausea or vomiting may also require urgent medical evaluation.

Safety Tips

Dr. Martinez-Silvestrini also offers the following safety tips when using hot or cold therapy:

  • Do not use heat or cold packs if you have poor circulation or diabetes.
  • Extremely cold ice can cause burns or frostbite, be sure to wrap ice or cold packs in a thin towel to protect your skin; the same applies for heat, to prevent burns place a towel between your skin and the heat source. Do not apply cold packs or heat to open wounds, which might be infected, irritated skin, or stitches.
  • Do not use heat or ice on areas with poor sensation.
  • Avoid placing ice packs to the front or side of the neck, as it may cause spasms of your neck blood vessels.

As always, when in doubt as to which therapy to choose, or if you should use heat or cold at all, call your physician’s office.