Ice or Heat?

Even after many years of providing care andproviding counsel in matters of self care we find one of the enduring points of confusion remains use and appropriateness of heat vs ice. These are two reasonably conservative interventions with long histories of use and effectiveness, as well as lack thereof.  Two modalities used and misused by well meaning people for centuries, let’s look at what we might expect from each.

What To Expect From Heat Therapy

Heat therapy- Many modalities, such as ultrasound and others as well as good old fashioned heat pads are actually heat modalities and they can have some desirable effects. Heat has been shown to promote local vasodilation and accelerate some metabolic processes and has also been demonstrated to have a relaxing effect on musculature, all of these can have a place in the care of a given situation. An important caveat is to distinguish between hypertonic muscle, spastic muscle and trigger point. The latter two are not always helped with heat and my experience has been that some trigger point presentations can be provoked with the application of heat.

Using Ice Therapy Effectively

Ice, or more correctly, cryotherapy, can have a variety of effects depending on the application. The classic use is to inhibit inflammation and to promote analgesia, both of which are the effects of traditional cryotherapy employment. Cryotherapy has other realms of effectiveness, however, among which is the possibility of effecting a focus of vasodilation with discriminant application. Attention has been given to many applications of cold to include partial and whole body exposure; athletes have long used immersion in ice water tanks but, as happens so much in the field, attributing specific effects to these processes is difficult yet necessary in order to be able to employ them clinically. We have had much success with cases which were unresponsive to many other treatment types by using cryotherapy in a focused and deliberate method.

Deciding Which Option Is Right For You

Much more could be said of each of these categories of intervention, but more enlightening to our consideration is the recognition of the importance of accurate diagnosis in order to be able to meaningfully employ an intervention, be it ice, heat, mobilization, immobilization; really any effort at care becomes just stumbling in the dark without some concept of the purpose of the ministration. This is where the real confusion lay many times, in my experience, as different injured states of either muscle, tendon, ligament or other connective tissue, either acute or chronic might respond favorably or unfavorably to any of the aforementioned treatments.

Lastly, and importantly, one must be mindful of possible harms from any of these things when self employed. Ice and heat are capable of damaging skin and other tissue, sometimes severely. Careful application of these things can help avoid a trip to the doctor but conditions which are unresponsive to reasonable, safe efforts at self care should be seen by a professional.

– Dr. Donaid Seals