Orthopedic Specialists

Ice, Heat, or Both?

July 11, 2018

Boy deciding on right or wrongYou went a little overboard at your aerobics class and are feeling it in your knees.  The arthritis in your hands is really causing achiness and stiffness today.  Do you use ice, heat, or a combination of both?  Here is some basic information to help you make the right decision. 

As a general rule of thumb, ice is used for acute injuries or pain along with inflammation and swelling.  Use heat for muscle pain or stiffness. 

Heat therapy works by increasing circulation and blood flow to a particular area with the increased temperature which can help relax and soothe muscles and damaged tissue.  There are 2 different types of heat therapy, dry heat and moist heat.  Dry heat includes a heating pad, dry heat packs, and even saunas.  It is easy to apply.  Moist heat includes steamed towels, moist heat packs, or hot baths.  Moist heat may be slightly more effective and can require less application time for the same result.

There are certain cases where heat therapy should not be used.  With bruising, swelling, or both it may be better to use cold therapy.  Heat should not be applied to an area with an open wound.  Also, people with certain medical conditions should not use heat therapy due to higher risk of burns or complications.  These include diabetes, dermatitis, vascular diseases, deep vein thrombosis, and MS.  If you have hypertension or heart disease, ask your doctor before using heat therapy.  

Heat therapy is often helpful when used for a good amount of time, sometimes 15-20 minutes is sufficient to help ease stiffness or tension.  More severe pain can benefit from longer periods of therapy with heat like a warm bath, 30 minutes to 2 hours.  Risks of heat therapy include burns to the skin if the heat becomes too hot.  If you have an infection, the heat therapy could increase the risk of the infection spreading.

Cold therapy is also known as cryotherapy.  It reduces blood flow to a particular area reducing inflammation and swelling which can help ease pain especially around a joint or tendon. It also reduces nerve activity which can also relieve pain.  Types of cold therapy treatment can include ice packs, coolant sprays, ice massage, or ice baths.

People with sensory problems that prevent them from feeling certain sensations should not use cold therapy, especially diabetes, as this can result in nerve damage and lessened sensitivity.  Cold therapy should not be used if you have stiff muscles or joints and also if you have poor circulation.  You should never apply ice or a frozen item directly to the skin; it could damage the skin and tissues. Cold therapy should be applied as soon as possible after an injury and be used only for short periods of time, 10-15 minutes and no longer than 20 minutes.  Risks of cold therapy include skin, tissue, or nerve damage if the cold is applied for too long or too directly.

Some injuries or problems can benefit from the use of both heat and cold therapy.  Cold therapy can help with the initial inflammation and swelling of an acute injury and help numb the pain.  Once the swelling has gone down, heat can increase blood flow to help ease the stiffness and soreness in the area. This is often the case with arthritis swelling and pain.  It is often recommended to use a 20 minutes on, 20 minutes off process with heat and cold therapy.

In summary -  ice wins for acute pain, inflammation, and swelling.  Heat wins for arthritis and injuries that linger more than six weeks.  If these therapies are not providing relief after consistent treatment, you should contact your physician for an evaluation to insure there is not a more serious condition involved.  The Orthopedic Specialists providers are here to help with all of your bone and joint issues, no referral necessary.  Call (515) 955-6767.  


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