Should I ice or use heat?
I am often asked which is better, ice or heat. My answer is; Ice is always safe if used properly. Heat may exacerbate your symptoms. Here is the general rule of thumb:
If it is a recent injury, always use ice. I recommend to continue with ice as long as the pain has a burning quality to it. Don’t just assume that after 24-48 hours the “acute” inflammatory phase is done. Icing may be used for weeks.
Make sure that your ice pack is wrapped in a thin towel or over a t-shirt. Don’t put it directly on your skin as ice (especially ice cubes) can damage your skin if left on for more than a few minutes. Ice with wrapped bag or gel pack for 15-20 minutes. Take the ice off and give yourself at least a 20 minute break. After the first 2-3 20min on and 20min off give yourself about 40 minutes between icing. In other words 20min on and 40 min off or 20min per hour.
Occasionally direct ice is used on a focal area of injury. You can freeze some small Dixie cups full of water and tear about ½ inch off of the paper around the top of the cup exposing the ice. (The cup helps you to hold the ice without freezing your fingers. You can use an ice cube wrapped in a paper towel as well). Move the ice in a small circular motion over the affected area. It will feel cold, then burn, then ache, then it will start to feel numb. When it is numb stop. When using direct ice, do not go more than 5 minutes even if it does not feel numb yet.
Heat is great for chronic ache and stiffness. Especially in the mornings, heat can loosen stiff muscles and joints and help get you moving. A hot shower or heating pad for 15-30 minutes works well. A soak in a hot tub for 15-30 minutes can be nice. Do not do this if the injury is recent. I have had patients get into trouble using heat. It can be counter intuitive because heat can feel very good, even in the acute phase of injury, but it opens vasculature and can draw in fluid to an already inflamed and swollen area causing the area to have more pain later on.
Occasionally heat can be used in the sub-acute phase of an injury. If heat is used, place the heat pack on the affected area for 5 minutes followed by ice for 10 minutes. You can alternate using this frequency back and forth multiple times. Always end with ice, preferably 20 minutes for the final icing.