Should I Use Ice or Heat for Pain?

Heat applied to an ankle

Should you use heat or ice on your painful injury? The best method of solving this important riddle is to assess the nature and source of the pain. Essentially, a new injury, that is, one that you sustained within the last 48 hours, is best treated with ice. Chronic pain, or pain that you have had for a long time, is generally best treated with moist heat. Understanding the mechanisms of injury and the physiological and biochemical causes of pain helps us to differentiate the indications for applying ice or applying moist heat.

The primary rule is that you can never go wrong with applying ice. Ice calms things down and, although an ice application may be uncomfortably cold for a few moments, the overall effect is soothing. Cold decreases local metabolism and constricts small blood vessels (arterioles). Cold reduces nerve conduction velocity, that is, the speed at which nerve impulses are transmitted, and therefore reduces the number of pain signals that reach your brain per unit time. Thus, ice applications provide vasoconstriction, analgesia, and sedation. Ice is indicated for acute musculoskeletal injury, burns, insect bites, bleeding, and snake bites. Ice should not be used for gout, rheumatoid arthritis, Raynaud's phenomenon, history of vascular impairment, and cold allergies. As well, ice should not be used for a patient in a coma.

Moist heat increases local metabolism and dilates small blood vessels. Vasodilation results in increased nutrition, increased activity of white blood cells (phagocytosis), and increased removal of waste (metabolic end-products and damaged cellular structures). Moist heat provides analgesia, sedation, and reduces muscle spasms. Heat is best for chronic pain and muscle spasms. Contraindications to moist heat include acute musculoskeletal injury, area of diminished sensation, acute skin conditions, pregnancy, malignancy, diabetes, encapsulated swelling, hemorrhagic disorders, and suppurative conditions.

Generally, ice applications are used for acute injuries within a 72-hour time frame from the onset of the injury. Acute injury damages local capillaries, causing blood to leak into the spaces between cells and tissues, where it doesn't belong. Such uncontained blood causes pressure on local nerve endings, creating pain. Also, pressure is applied to nearby cells, causing extended injury and possibly cell death. Thus, limiting the amount of blood leaking out of disrupted capillaries is critical in slowing the effects and reducing the impact of musculoskeletal injury. Ice performs this function. Ice reduces swelling, reduces pain, and provides a sedative effect.

When applying ice, it's very important to avoid damaging the skin. Ice packs should always be wrapped in a towel. Ice should rarely be applied directly to the skin. Duration and frequency of ice applications is not an exact science, but a useful guideline is to apply ice for 15 minutes every two hours for a moderately acute injury, using three to four ice applications per day. However, you will know instinctively when the time is right to apply the next ice pack.

Moist heat applications follow similar guidelines. Dry heat should never be used. Moist heat packs should be wrapped in a towel and are applied for 15 minutes every two to three hours, up to several applications per day.

Recovering from injury requires your body to put forth a great deal of effort and requires support from the nerve system, the body's master system. Regular chiropractic care provides great assistance in the process of recovery from an injury. By detecting and correcting spinal misalignments and sources of nerve interference, regular chiropractic care helps ensure optimal functioning of the nerve system. Thus, regular chiropractic care helps facilitate your recovery and helps you return to your full range of activities as quickly as possible.

1McCarberg B, D'Arcy Y: Options in topical therapies in the management of patients with acute pain. Postgrad Med 125(4 Suppl 1):19-24, 2013

2Piana LE, et al: The Cold, Hard Facts of Cryotherapy in Orthopedics. Am J Orthop (Belle Mead NJ) 2018 Sep;47(9). doi: 10.12788/ajo.2018.0075

3Mayer JM, Mooney V: Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil 87(10):1310-1317, 2006

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Testimonials

  • "Dear Dr. Zabawa,
    I want to thank you for being my #1 healthcare provider.
    I have been under chiropractic care for 40 years and of the many chiropractors I have been treated by,
    you and your precise atlas adjustment are the best.
    It really is gentle and effective. I've had migraines, scoliosis, herniated L4-L5, and sciatica -
    and in the 11 yrs of being under your care I have had no problems or re-occurrence of any
    of my former symptoms.
    You are the best and I thank you."
    Judy B.
  • "Hi, I'll always remember the wonderful things you've done for me at Atlas Chiropractic of Sarasota.
    I thank Dr. Zabawa for getting me up and running!
    My last chiropractor said there was nothing else they could do for me, and I felt as if my life was over.
    (I couldn't even play video games without pain.)
    Now that I've been introduced to your atlas adjustments: I'm lifting weights again, working (making money),
    and yes - even playing video games. Wow!
    THANK YOU!!!!!"
    Lyle H.
  • "We've had 40 years of various types of chiropractic therapies (sometimes weekly),
    but have never felt truly aligned until now."
    Marsha & Alain M.
  • "I was diagnosed with scoliosis as a child, and through good habits & care have managed to avoid surgery.
    About 30 years ago my research into spinal maintenance led me to upper cervical chiropractic
    (specifically orthospinology) over general chiropractic.
    This is just phenomenal. When my atlas is adjusted and my spine is aligned, it is amazing how good I feel.
    It helps the nerves and muscles of the body function so well, and I believe it has been the key to slowing
    the spinal degeneration caused by my scoliosis.
    * And it's so non-invasive! *
    Now that I live in Sarasota, I am so glad to be under the care of Dr. Zabawa.
    It's no surprise that he came highly recommended. I have always been impressed with
    the professionalism and care I've received at Atlas Chiropractic of Sarasota.
    It compares to anywhere in the country."
    Kyle Ann M.
  • "Very thorough. Quick recovery after a car wreck!"
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  • "For 3 years I had been having headaches every day.
    I even went to a neurologist for my headaches, but he said they were a condition of menopause :(
    A friend suggested going to Dr. Z because of the unique procedure he uses and the great results.
    Dr. Z took care of me and within about 3 months my daily headaches were gone.
    What a relief!
    I don't think I've had one since :)"
    Allaesia M.
  • "I lived in pain with an undiagnosed broken back for 23 years since a horse & buggy accident as a teenager.
    When I injured my back again as an adult, the x-rays showed that I had fractured a vertebra back then,
    as well as this time.
    I received some help from going to regular chiropractors in recent years, but still lived in pain.
    I am so thankful that I found Dr. Zabawa.
    After 35 years and lots of pain, within a month or so
    I was PAIN FREE!
    It is amazing how such small adjustments to the atlas vertebra in my neck have made such
    a big difference to my life.
    To this day, I come in periodically to maintain my new found health.
    Praise and glory to God."
    Mary T.