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Heat vs. Ice: How and when to use

Updated: Sep 22, 2022

The elements of heat and ice for therapy are very effective. Most people are aware that ice is used for reducing inflammation typically in our joints where there has been an injury. There is no doubt that ice is the most effective for reducing inflammation and any kind of swelling in this instance. Many people don't realize that ice is very effective for soothing muscular pain as well. It helps relieve inflammation from over activity and repetitive motion that builds up in the muscles from this over use.

I recommend that people use ice after a hard workout, a stressful day or working long hours. These activities fall into the category of heat because when you feel pain or discomfort in your neck in shoulders or low back it is basically the muscles becoming inflamed. The word inflamed accurately describes heat. So that is why I recommend the ice as it helps to cool down the area and move the pain away. I will explain later how heat is not as effective but alternatively can be used for muscle therapy.

How to apply ice for the best results

Ice is extremely effective for relieving low back pain. If your low back hurts after activity of any kind it is best to put ice on the effected area right away to reduce the pain. Leave the ice on for about 10-15 minutes. No longer than 20 minutes. T

he ice effectively reduces inflammation and moves the pain out of the area where it normally stays. Be certain to use a large ice pack. Nowadays there are many on the market that are made of the gel. Make sure you get a large one that will be very cold and be able to cover the larger areas of your body. For the smaller areas, the ice pack will be able to wrap around the joints etc.

Also, the larger ones stay colder longer and sometimes you only have to leave it on for 10 minutes. Look for the kind shown. These are great and they fit right on the bottom of your freezer. I recommend having two however make sure you always have at least one in the freezer all the time, ready to use. When it comes to being healthy and active, these are your best friends.

How do I know exactly how long to leave it on?

You need to get the effected area you are trying to relieve with the ice very cold. However, you do not want to freeze the area. Freezing is when you can't feel the area you are applying the ice to anymore. For example, I may put ice on a client after I do some bodywork. After about 5 - 10 minutes, depending on the area being iced, I ask the client how it feels. If they respond that they can't feel it anymore then they are done. If it isn't quit there yet I leave it on for another 5 minutes or so. When icing, the philosophy of more is better doesn't necessarily apply. If you freeze the area you get to a point of diminishing return. That is the area locks down and restricts blood flow rather than facilitate it.

However, sometimes we do need more. This is accomplished by applying a second round. In my office, I usually only do one round however if needed and we have the time I will give them a second dose.

How do you know if you need a second dose?

The way to know if you need a second dose is to pay attention to how long it takes for the area to warm back up on its own after you remove the ice for the first time. Assuming you got it very cold, it warms up pretty fast then you probably could use another dose. Also, check in with your body and intuition. If the first round felt good and gave you relief and you feel you could use some more then go for it. Once the area has warmed back up then reapply the ice. Again, let it get very cold and then remove. After this second dose, you are done.

For those who are using this for neck and shoulder pain after a day of work or over exertion you most often only need to apply the ice for one round. You will know because if you have gotten the area very cold and it stays fairly cool for some time after you take off the ice then you are good. You have effectively reduced the "flame" in the inflammation. This is the goal and you should feel much better after you iced down.

After the initial shock when applying the ice, If you experience any burning or stinging sensation please take it off. Burning or stinging is your bodies way of rejecting the therapy and most likely you will not receive any benefit and likely create more pain and discomfort in the area. Which leads me to discuss how you know whether the ice therapy is effective or not. You should feel relief and less pain after icing. If however, you feel more pain and discomfort then discontinue icing.

By the way, never use the ice packs directly on the skin like the person is doing in the picture you see here. I recommend using a pillow case as a thin protective barrier between the ice and the skin. If you are really sensitive to cold you can use a thin towel. This way you can control the intensity. Just remember that it won't get as cold as fast. So you may have to give it more time.

Now that you know how to use ice more effectively let us talk a little about heat.

Most of us have used a heating pad one time or another to reduce pain. Sometimes it does work. However, most often we just think it works because as long as we have the heat on we don't feel the pain and therefore feel better. When asked, clients often report that the pain returns fairly soon after they remove the heat. The reason this happens is because the heat effectively "masks" the pain by overriding the pain receptors that lead to the brain. The heat basically stimulates the nervous system and as a result you feel better temporarily as long as you have the heat on. You may have experienced this and soon after you remove the heat the pain comes back. Ice on the other hand is very good at moving the pain and discomfort out of the area. This is especially true of the low back.

Why does this occur?

Energetically, Heat is attractive in nature. Think of a hug in which we are attracted to find comfort. Ice on the other hand is not usually welcomed and we often work to stay away from the cold. It is detractive in nature and pushes things away. Therefore, if we want to get rid of pain we would apply ice.

Now, I know that I said not to use heat. This is because most things we do are creating heat or an inflammatory effect in the body. Again, activity, heating pads, hot shower, hot tub and of course massage is a form of heat therapy which increases blood flow. In these cases we are usually called to ice. However, if you wish to do your own "muscular therapy" on general areas of the body you can alternate the heat with the ice. By combining the two we create a pumping action for your blood flow, energy and pain. This effect is created by applying a heat element (activity, massage, heating pad, hot tub or jacuzzi) then follow this with ice on the painful area. Leave on for 10-15 minutes and then reapply heat or leave alone to warm up naturally and then reapply the ice once again for 10-15 minutes. When the area is nice and cold remove the ice and your done. You should feel a significant difference immediately.

So for muscle therapy in which the soft tissue IS NOT INFLAMED by injury, apply heat, then ice. Heat again (or warm up naturally) and then end with ice. Remember that it is not best to add heat to heat, which means after activity (heat) do not use a hot tub or heating pad. Use the ice right away.

These tips are most useful for general therapy. Every person is different and responds to therapy in different ways. Use this as a guideline but find out what works best for you and stick to it. Trust your intuition and follow through with the therapy to get the best results. Here is a link to purchase the current ice pack that I use in my office and recommend to have at home. Use the link to support my ability to continue to provide education, products and services that help you and others live better!

Written by David Rice, HHP, CMT

Balance Point Massage

Copyright 2007

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