by Dr Paul Park
The most common question we doctors are asked by our patients is:
“Should I put an Ice or Hot pack on my injuries?”
For many years the battle between the two therapies has never resulted in a true winner. They both work effectively however, based on the type and the timeframe of an injury, one treatment is more effective than the other. This blog will help you decide which to use whenever you get a pain or injury.
When the tissues undergo macro or microscopic injuries, the body starts an inflammatory response. In a cellular level, the injured tissues will release chemicals (Chemokines) which results in releasing inflammatory mediators from local immune cells. These mediators cause local blood vessels to increase in size. Then, the plasma and white blood cells are moved outside the vessels around the injured site to help the recovery and healing process. This causes the swelling, redness and sometimes even heating around the injured site. However, these mediators also stimulate the nociceptors around the site which are responsible for pain. From understanding the mechanism of inflammatory and pain response, we can now decide which therapy might work best.
We ask patients to use ice packs on injuries if they are acute or if swelling and/or heat is generated at the injured site (for example acute bursitis at the shoulders, acute joint pain or acute discs). Cold treatment reduces the blood flow to the injured area and as a result decreases the swelling and further tissue damage. Also, lowering the temperature numbs the sore tissues which can act like a local anaesthetic. Therefore, it can relieve pain, but will not repair tissues faster than heat therapy.
Applying an ice pack within the first 48-72 hours will be most effective. Ice should be applied for 10-15 minutes for every hour until pain is relieved. But no more than 20 minutes due to possible nerve, tissue, and skin damages. If possible, RICE (Rest, Ice, Compression, and Elevation) should be applied when using cold treatment. You should not use cold therapy if you have some sort of sensory disorder that prevents you from feeling cold, stiff muscles or joints, or poor circulation.
We ask patients to use hot packs on injuries if they are chronic and more for muscle and joint stiffness (for example chronic joint stiffness from arthritis, chronic muscle pain and cramps, or chronic tendonitis). Heat treatment increases the blood flow to the injured area and help to boost metabolism for recovery at the site. Heat also improves tissue extensibility and range of motion of stiff joints. Therefore, heat helps tissue recovery much faster than cold therapy.
Apply heat for 20-30mins at a time until your muscles feel relaxed. Heat therapy should not be used if you have a sensory disorder that prevents you from feeling heat; the area is swollen, red and hot; dermatitis or an open wound.
And the winner is...both!
Cold and Heat therapies are both effective depending on the injuries. If the injury consists of acute pain with swelling of the joint or muscle, then ice will work. If the injury consists of chronic pain with joint or muscle stiffness, then heat will work. Knowing when to use cold or heat therapy will significantly increase the effectiveness of the treatment. Some situations will require both. Arthritic patients, for example, may use heat for joint stiffness and cold for swelling and acute pain. However, the best treatment out of the two for an individual is the one that feels comfortable and minimize pain for them. If you are not sure, ask your doctors for their opinions.