When to Use Heat Versus Ice
Everyday in my chiropractor and sports based practice I offer home care advice in the form of stretches, strengthening exercises, and hydrotherapy.
Here is my criteria and reference guide for hydrotherapy use:
Ice pack– 10 minutes on, 30 minutes off. Repeat as necessary.
Ice massage– Using an ice cube, continually move it around the area for approximately 4½ minutes. NEVER leave the ice cube on an area without moving it around or you will burn your skin. Do not engage in any activity using the affected area for at least 20 minutes post ice massage. Repeat the ice massage at least twice daily.
Heat- 20 minutes on, 20 minutes off. Repeat as necessary. Moist heat is always the best option (wrap a heat back around a moist, warm towel)
Contrast Therapy– 3 minutes of heat, followed immediately by an ice pack for 2 minutes. Repeat until the total time allocated is 15 minutes.
If the area is swollen or bruised, and the injury just happened, always refer to ice. If the area is a muscle (low back, quad, hamstring, bicep, etc), an ice pack is best. If the area is a joint (knee, ankle, shoulder, SI joint, etc), ice massage is best. The rationale behind this option is you are trying to reduce inflammation by applying ice to the area. Muscles have more blood supply than connective tissue (tendons, ligaments, or capsules) so an ice pack is sufficient to decrease the size of the blood vessels and redirect the inflammation away from the site. In order to create the same effect in the joint or connective tissue, ice massage is necessary.
Another way to determine whether to use ice, heat, or contrast is to consider how you would describe the injury or area affected.
1. If you describe the affected area as “tight or stiff” ONLY (no pain or discomfort), heat is indicated.
2. If you describe the area as “sharp, twingey, throbbing, or swollen,” ice or ice massage is indicated.
3. If you describe the area as “sore, achy, throbbing, burning, painful, and any of the above descriptors, contrast is indicated.
If you have no pain or discomfort and simply want to encourage increased flexibility of a muscle, consider applying heat to the area for 10-15 minutes. Perform your stretches immediately after.
Please note the above is meant as a general guideline! I still advocate seeking out professional advise if you have sustained an injury.
Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic