Toronto Health & Physical Rehabilitation Clinic

Heat vs. Ice
Dr. Joe Ghorayeb

For years a debate has existed on which therapy is best following an acute injury. Among the many therapies, there exists a continued disagreement on the roles of heat and ice. A great deal of misinformation and misconception exists on this topic. So let’s get to the bottom of this debate.

The argument for Ice:
Applying ice to an injured area creates a response in the body known as vasoconstriction. Vasoconstriction limits the amount of blood that enters an area by causing the blood vessels to shrink. This is important because it decreases the amount of inflammation in an injured muscle or joint.

The argument for heat:
By contrast, when heat is applied to an injured area vasodilationoccurs. This causes increased inflammation in the affected area. Heat also feels good and gives the feeling that the muscle/joint will loosen up and be more relaxed.

In the end, Ice wins!

While it certainly doesn’t feel as good as a warm heat pack, icing is the way to go. People naturally question this. Some of us have grown up with the idea that you heat an injury. Some of us have even been told by health care professionals to use heat.

So why use ice? Inflammation, which is promoted by heat, is beneficial. Without it, normal healing could not occur. However the body tends to overreact and the inflammatory response results in excess of what is actually required for healing purposes. This creates a scenario where the body has too many “cooks in the kitchen”. The healing processes become less efficient and recovery is prolonged.

So how do we apply ice to an injured area?

10-10-10

10 Minutes On

• Place the ice pack on the injured area. It should never be placed directly on the skin, but also never through more than one layer of clothing (like a t-shirt).
• Apply compression to the affected area. This helps the cold to conduct better.
• Ice the area for 10 minutes; no more and no less. 10 minutes.
• The goal here is to cool the skin and superficial layers of muscle tissue.
   

 10 Minutes Off

• Take the ice pack off the area now and throw it back in the freezer. Wait 10 minutes before reapplying.
• The goal here is to allow the skin and superficial layers of muscle tissue to warm back up a little and for the cold to penetrate to the deeper tissues. It prevents overcooling of the skin and eliminates the risk of frostbite.
   

10 Minutes On

• Repeat the application as described above in Step One for a final 10 minutes.
• The goal here is to re-cool the superficial tissues and to lock in the cold in the deeper tissues.
   

Wait at least an hour before repeating the cycle. If possible, try to attain 5-7 cycles in a 24 hour period. (Hey, no one said recoverry was easy).

Does this mean we should never use heat?  For an acute injury yes, but not for chronic nagging injuries.

Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy. Athletes with chronic pain or injuries may use heat therapy before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow. Heat can also help relax tight muscles or muscle spasms. Don't apply heat after exercise. After a workout, ice is the better choice on a chronic injury.

Again be sure to have a layer of clothing, or a towel, between a hot pack and the affected area and do not leave the heat on for more than 15-20 minutes at a time.