The Great Debate: Ice vs. Heat

It has long been debated whether ice or heat is better to treat pain. A study published by Garra G et al. in 2010 researched the efficacy of heat and ice in treating neck and back pain, concluding that both treatments provide mild relief. According to this study, the best option is whatever the patient feels most inclined to try. Especially in low back pain and neck strain, people are more likely to want heat, so they achieve relief simply by satisfying that need. “The only real leverage hot and cold packs have is on our nervous system — alarming or relaxing, soothing or irritating — and that in turn is strongly determined by context and how we feel about it.” To elaborate, heat is often thought of as comforting, or with a relaxing element. A hot pack therefore does not tend to “alarm” the brain, as would an ice pack being placed onto someone’s bare back. One may think of going to a spa for a full body massage, where warm oils or heated rocks are used as part of the treatment, thus garnering the correlation of heat to being soothing. Versus the shocking and breath-taking element of, say, the “ice bucket challenge” in which thousands of individuals poured freezing ice water onto themselves.

The bottom line?

• Ice should be used to reduce areas of inflammation and for acute injuries.
o The key characteristics are redness, swelling, pain, and warmth.
o To counteract this heat and reduce the swelling, ice is most often used as the initial treatment for soft tissue injuries such as sprains and strains.
o Soft tissue injuries, or STIs, are damages of muscle, ligaments, and tendons.
o Heat will make inflammation worse and will lead to more pain around injury site
o Ice can be applied using an ice pack covered by a cloth, never directly onto the skin in order to avoid further tissue damage.

• Heat is best to relieve tightness, tension, pulled muscles, and chronic pain
o May be better for chronic pain to give temporary relief
o Chronic low back pain, for example, welcomes heat therapy much more than it would ice.
o Chronic pain, stiffness, and soreness can be treated using heat because heat helps the muscles relax, which then improves blood circulation and reduces muscle spasms.
o Heat also treats trigger points. While they are not complete muscle spasms, they are tiny muscle cramps, which tend to be aggravated in the cold. These sensitive areas of soft tissue are likely what individuals are referring to when they mention a “knot” in their neck, for example.
o Heating pads use dry heat and steamed towels use moist heat to provide the soothing heat. Paraffin wax is used to relieve pain, most commonly as a hand dip for those with arthritis.

And why not both! Introducing contrasting therapy:
• Contrasting therapy act of the immediately switching between heat and ice to make muscles more adaptable to changes
o Contrasting therapy is a quick solution mostly used with athletes looking to recover from a competition and get back in game.
o Easy and cheap solution – little risk of harming the muscles, as it allows your muscles to work out, due to the stimulation of the contrast, without the stress of a physical workout.

 However, more research needs to be done
Ultimately, it is best to use “whatever feels best”
o “Ideal uses of ice and heat are roughly equal in potency” (Paul Ingraham, PainScience.com)
o Using ice when already cold can lead to more muscle tension, and using heat when the body is already hot may shock the body
o When individuals change their mindset from believing that heat is a cure-all for any and all chronic pain, they may find that ice is able to soothe them as well.

References:
Garra G, Singer AJ, Leno R, et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med. 2010 May;17(5):484–9. PubMed #20536800.

By Jennifer Santamaria PT, DPT