At no time should icing, or any other advice given here be construed as treatment recommendations for any type of medical or chiropractic condition. Always consult with your physician before trying any home care program if you have any questions, concerns or considerations.
Patients frequently ask me if they should use ice or heat when experiencing pain. As a general rule I recommend ice for acute injuries- those injuries that are less than 72 hours old, and where redness, swelling and/or sharp, stabby-jabby type pain is being experienced; and heat, where pain is chronic and feels more like muscle stiffness, soreness and/or achiness.
As with anything, there are always exceptions to any rule and where ice or heat are not well tolerated by an individual, or where a person has a known medical condition that would make ice or heat counter-indicated, these modalities should not be used without medical or chiropractic supervision.
Icing Instructions (Within the first 72 hours)
The purpose of ice is to reduce the effects of inflammation, and swelling.
Ice should never be used on bare skin. Always apply ice over a towel or piece of cloth.
Depending on the size of the area being treated, the longer I recommend icing. For example, smaller joints and the neck about 10-12 minutes per hour that you are awake. Bigger areas like the low back, about 15-20 minutes per hour you are awake.
Icing should continue until swelling and/or pain have reduced and symptoms are more stiffness than any sharp, shooting, stabby-jabby sensation. This should occur in the first 72 hours or so after injury.
Alternating Ice and Heat Instructions (Next 2 weeks)
After a few days when the sharp, stabby-jabby pains, and swelling start to abate, one can use alternating ice and heat. This can be a little tricky so I generally recommend using moist heat in the morning upon rising, and then icing more toward the end of the day. With activity the healing tissue can tear and cause sub-acute inflammation which should be addressed with ice, but while the tissue is scarring and remodeling, moist heat would be best to increase circulation and nutrients necessary to promote healing.
Another way to alternate ice and heat would be to ice for 2 minutes, heat for 2 minutes then ice again for 2 minutes before ending.
There are ways to use alternating ice and heat, but this can be tricky if you don’t know what you are doing.
Basically where there is pain there is inflammation and ice is best to put out the fire. When the fire is out, and symptoms align more with stiffness and soreness it is important to increase the circulation to help the tissue repair and remodel. Moist heat is best.
Heating Instructions (After 2 weeks)
Heat is best to use when symptoms are more stiffness and achiness, or where it would be desirable to increase circulation AFTER inflammation has abated. This would be approximately 2 weeks after injury.
It is my opinion that heat for acute injuries or within the first 72 hours post-injury will do more harm than good, and should be avoided.
I recommend using a moist heat such as a hot water bottle with a moist towel, a shower/hot tub or a heating pad THAT IS Underwriters Laboratories (UL) APPROVED FOR USE WITH WATER. Regular heating pads tend to dry the injured tissue out.
Heat should be used to the point where a soothing sensation is felt. This means that circulation has been increased to the healing area, and this would be a good time to discontinue moist heat.