To Ice… or Not to Ice?

When is it right to use ice on an injury, versus heat?

Let’s look at what happens after an acute injury. Imagine you bend forward to pick something up off the floor, and you feel a sharp, painful pinch in your lower back. Chemicals are released from the spinal joints and tissues at the sight of the injury that cause local blood vessels to flood the area. This swells and pressures the injury in an attempt to brace it. These chemicals also irritate local nerve endings, causing pain to let you know the area is injured. Lastly, these inflammatory chemicals act as messengers that tell the immune system to begin laying down fibrous scar tissue around the joint to spackle it in and repair it. The end result- you feel stiff and sore, and, over time, may be left with long term aches and immobility in your lower back due to the scar tissue used to repair the area.

The reason, as chiropractors, we recommend ice after an acute injury like this is that it buffers this inflammatory response. We understand that long-term happiness for the muscles and joints of the body lies in them being able to move and function flexibly. Ice prevents swelling from getting out of hand, provides natural pain relief, and prevents scar tissue from being laid down in excess. Thus, the injury heals better, faster, and more comfortably, and ends up more flexible and functional down the line.

Heat tends to be most effective when used on more chronic injuries and aches to keep them flexible and comfortable. Use it on areas of chronic muscle tension, to reduce achiness from chronic arthritis, or as a means of improving body flexibility prior to exercise and activity. Avoid heat in the initial stages of an acute injury or pain flare-up.

Simple Guidelines for Use of Ice vs. Heat:

  1. Use ice in the first 48 hours after an acute injury or significant flare-up of pain.
  2. 20 minutes is the magic number when using ice. Apply for 20 minutes every 1 ½ to 2 hours.
  3. After the first 48 hours following an injury, try “contrast therapy”- a mix of heat and ice. A good contrast therapy schedule is heat for 15 minutes, followed immediately by 10 minutes of ice.
  4. Much like ice, when using heat on chronically tight muscles or achey joints, limit the application to 20 minutes.
  5. Always ice or heat through a thin cloth to avoid irritation and damage to the skin.
  6. Flexible gel ice packs, bags of frozen peas, or crushed ice in a zip-lock bag all work well for ice therapy.
  7. To make a homemade heat pack, put 1 to 2 cups of dry rice in a sports sock and tie off the end. Microwave for 60-90 seconds, and you have an effective moist heat pack for relieving aches and tension.
  8. Ice massage is a wonderful way to provide relief for repetitive stress injuries like tennis elbow. Fill a Dixie cup with water, and freeze it. Tear off the upper rim, exposing the ice, and gently massage it over the irritated area for 2-3 minutes to reduce pain, inflammation and scar tissue accumulation.
  9. Never ice before exercise or stretching.
  10. To combat chronic morning stiffness, try a 20 minute soak in a bath or hot tub.