Ice or Heat?

One of the most frequently asked questions at my office is,"Should I use ice or heat for my pain?" The patient generally goes on to say, "My primary doctor tells me to use which ever feels better, the physical therapist tells me to use heat, and the chiropractor tells me to use ice. I am so confused." I usually reply, "Put ten doctors/chiropractors/ physical therapists in a room and ask a question. You will get eleven different answers."

I will share some scenarios to give you a better idea of which application to use--ice or heat. If you are not sure what to apply, use ice. When an athlete gets injured, you will see him or her immediately receive an ice pack.

For injuries, it is best to use ice, not heat. If you are experiencing a flare-up or aggravation of a condition, use ice. For headaches, I recommend ice. If you have a migraine headache and/or pain over the eyes and pain in the neck (a possible combination of tension headache and migraine), use the sandwich approach. Use one ice pack behind the neck and another ice pack over the eyes.

Stiffness in a muscle or joint responds well to heat. I always recommend moist heat or the heat packs you can microwave as opposed to an electric heating pad. For some reason, most folks achieve better results with the moist heating pad or microwave heating pad.

Let's talk precautions. Never use ice or heat directly on the skin as you could injure and burn the tissue. Always have some kind of buffer (towel, T-shirt, etc.) between you and the ice/heat pack.

Time is also an important consideration when applying ice or heat. In acute cases (a new pain), ice should be used as follows: 15 minutes on, 10 minutes off, 15 minutes on, 10 minutes off and ending with 15 minutes on. In this acute situation, you can repeat this sequence 1 to 3 times a day. If you are icing just once (e.g. after an activity,) apply ice for 20 minutes. You can apply heat for 20 to 30 minutes at a time.

Some of my patients have an aversion to ice. If you are one of those people who react rather than respond to ice, I strongly recommend the following: Put a thin bath towel in the clothes dryer for 20 minutes. Then place the ice pack in the towel and apply to the affected area. Initially you will feel the warmth,then a cooling effect. You can apply this ice/heat for 30 minutes. If your pain does not decrease in three days, I strongly recommend that you see your doctor for an examination.

That's it for now. Stay Well, Stay Healthy!

To Your Health, Wealth & Happiness!

Dr. Michael J. Kaye
Knowledge, Action, Results