Ice or Heat for Pain?

16 Dec Ice or Heat for Pain?

Thermotherapy and Cryotherapy are two complete different methods to treat pain. But if you have pain, how do you know which one to use? That depends on several factors, primary what is the source of your pain (what’s causing it), what are you trying to achieve (decrease pain for example) as well as safety concerns (if your pain is due to a cut please don’t use heat on it).

So looking at what is actually happening anatomically and reason for your pain in the first place can make you reach for the right selection. Muscle pain responds very well to heat. Pain that is caused by over-exertion (for example after a marathon), muscle spasm or muscular trigger points (muscle “knots”) responds well to thermotherapy but yet it is often mistaken for other problems as well. Going to see your health practitioner to rule out those other problems can be a decisive factor here. We want to make sure that our source of pain isn’t caused by “red flags” and rather that it is just a simple trigger point or spasm. Once we can figure this out, understanding of heating is relatively basic. Heat can help with extensibility of collagen tissues thus in the process decreasing stiffness, pain and increasing blood flow. This increase in blood flow can provide more nutrients and oxygen for tissue repair.

So again, heat is good for acute muscle soreness as from over-exertion, the kind of pain you get after your first ski trip of the season or first run after taking a long time off. It is also good for stiffness, trigger points, cramps (not due to heat cramp!) and muscle spasms. Some of these example are prime reasons behind postural issues. Osteoarthritic and rheumatic pain, fibromyalgia and sleep deprivation can also respond well to heat therapy.

Heat is not to be used and applied to a fresh injury (ie. Acute ankle spain), open cuts and infections. For acute ankle sprains use ice! Basically if the superficial tissue is sensitive to touch, if you see changes in the pallor of the skin, if there is swelling, heat should not be used. This is a little bit challenging for patients who are in chronic pain complaints however for our purposes today, let’s focus on acute fresh injuries and not on patients with chronic problems – that’s a totally different ballgame.

One important factor is differentiating between a muscle strain and trigger point. A strain is an actual physical rip in the muscle, not enough to be considered a muscle tear but microscopically some of the fibers are actually torn. It is physical damage while a trigger point or a muscle “knot” is a patch of tissue that is irritable. Muscle trigger points tend to respond very well to heat, muscle strains do not and you don’t want to put heat on a strain. This is why again the importance of seeing your musculoskeletal health practitioner goes a long way. The correct diagnosis of your pain/injury could lead to a better healing response from your source of treatment.

Sometimes we just need a simple re-assurance. Heat is associated with warmth and comfort and ice is just freaking cold! But understanding why you are applying one over the other can make a big difference in how you feel because our brain is essentially the commander of our physical, mental and emotional responses.

We can apply heat or ice both locally or systemically. Whether you are using gel packs, thermopads, bean bags, heated bottles, ice packs or taking a sauna, bath or cryotherapy chamber – it is best to consult with your health care practitioner first to make sure you are choosing the right “weapon” for your pain and most importantly for safety reasons.

Dr. Vadim Farian

Junction Health: integrated medicine & rehabilitation

2927 Dundas St W, Toronto

647-748-LIFE (5433)