Heat or Ice for Pain?
Pain comes in many forms, from migraine headaches, to arthritis to sprained ankles and pulled muscles. But the big question for many is whether to grab a bag of ice or reach for the heating pad.
Dr. Nathan J. Savage, a physical therapist with Total Rehab Inc., and Tres Ferrin, outreach coordinator for McKay-Dee Hospital sports medicine and the medical lead for the Ogden Marathon, weighed in on the topic.
“The general rule is, use ice for the first 48 hours following an injury to reduce swelling and pain,” Ferrin said. “Swelling is not your friend when it comes to recuperating from an injury. It can cause muscles to shut down, such as when the knee swells, the quadriceps muscle group doesn’t function as well and loses strength.” Ferrin said swelling can also cause increased scar tissue formation.
“We want some scar to form after an injury but not too much, as excessive scar formation may cause restricted joint mobility and increased pain,” he said.
Savage said when discussing care of musculoskeletal injuries, the acronym RICE is often mentioned. This stands for Rest, Ice, Compression and Elevation. The primary goal of RICE is to reduce pain and secondary tissue damage that results from the inflammatory response after injury.
“For example, if you sprained your ankle, you would damage the ligaments and soft tissues that support your ankle joint. Additionally, you would damage the small blood vessels that supply oxygen and nutrition to your tissues, resulting in increased fluid to enter your soft tissues,” Savage said. “The increased pressure from these fluids escaping the blood vessels and entering the surrounding soft tissues causes secondary tissue damage and pain.”
So how can RICE help? Savage and Ferrin said rest from activities is important after an injury so there won’t be any further tissue damage. However, that doesn’t mean complete rest of all activity. Savage said in order to assist tissue healing, therapeutic activities as tolerated can be beneficial.
After an ankle sprain, for example, light ankle movements and bouts of getting up to walk frequently throughout the day are often well tolerated, help reduce swelling, and promote tissue healing and recovery.
Putting ice on an injury restricts the blood vessels and helps lesson secondary tissue damage and swelling. Ice also helps reduce pain. Savage said cooling of an injured area or tissue is helpful because it reduces the frequency and intensity of pain signals being sent from your sensory nerves located in your skin and surrounding soft tissues. Cold application can also constrict damaged blood vessels in the injured tissues, reducing the overall amount of swelling and secondary tissue damage that results.
However, Savage and Ferrin said to be careful about inappropriately applying ice to avoid problems.
“I prefer using crushed ice when I can because once it comes in contact it starts to melt, creating a water barrier between the skin and ice that protects the skin from freezing,” Ferrin said. “Cold gel packs kept in the freezer often are too cold to be applied directly to the skin without causing frostbite. When using these packs always place a towel or wash cloth between the cold pack and the skin to protect from freezing. I usually recommend not using cold or heat too long, no more than 15 to 20 minutes at a time.”
Savage also said it should be understood that the cooling effect of an ice application only penetrates about a half inch into the tissue. Therefore, some applications of ice are primarily for pain reduction and not for reaching deeper lying target tissues such as spinal discs.
Compression and elevation is important because injury causes fluid to escape into the damaged tissues. Compression and elevation helps to mechanically push this fluid back into the bloodstream.
“These, in conjunction with therapeutic movement, will help reduce the overall amount of swelling and secondary tissue damage,” Savage said.
After 48 hours, Ferrin said he uses whatever treatment is best for the patient.
“Some patients will do well with cold for headaches and arthritis and some will do better with heat,” Ferrin said. “So I tell my patients to use whichever seems to be the most effective.”
Applying heat to an injured area or for pain reduction can be very effective, particularly for reducing muscle tightness or spasm, Savage said. Heat will dilate blood vessels and bring increased blood flow into a tissue, which can facilitate healing. Heat and exercise are often used when treating injured tissues or joints that require stretching or increased mobility. Like ice, most heat applications only penetrate about a half inch into the tissue.
And just as too much cold can be dangerous, too much heat can be also, Ferrin said.
“I’ve seen patients who have used heat for prolonged periods of time and develop a mottled appearance to the skin,” he said. “This is an indication that too much heat is being used for too long and the tissue is beginning to be cooked. When this occurs it’s time to cut back on the heat.”
Although you need to use some common sense, Savage and Ferrin said heat and ice are relatively safe.
“Some folks have allergies to ice that cause an uncomfortable skin reaction. Aside from those instances, if heat and ice are applied with appropriate precautions and for the appropriate duration, few if any side effects will occur,” Savage said. “Even if someone applies heat when ice is more advisable, it is unlikely that they will experience any lasting problems aside from increased pain or swelling in the short-term.”
Finally, if swelling returns to an injured area, even if it is after 48 hours, get the cold back on and elevate the body part above the level of the heart.