By Dr. Steve Shirley
It is common this time of year to get questions on which is more appropriate after an injury, heat or ice. With the cold weather, nearly everyone will reach for the heating pad first after slipping on the ice or shoveling snow. While heat may often feel better at the moment, it usually isn’t nearly as affective as using ice. With an acute injury, there is usually some degree of inflammation involved and ice is a natural anti-inflammatory and pain killer. It is just not as fun as using a hot pack and it is difficult to consider using ice on your body when it is 4 deg. outside!
The general rule is “when in doubt, use ice.” The recommendation for how long varies all over the place but generally icing 15-20 minutes every hour for the first 2-3 hours is a good rule. Also, never put ice or an ice pack directly on your skin. I have seen several people give themselves frost-bite from doing so!
On the other hand, heat is a natural muscle relaxer and for mild muscle injuries can be quite beneficial. Several studies have shown that heat patches, which you can wear for hours at a time, can be of great benefit. Heat can, however, irritate an inflamed muscle or joint and make it worse.
So, how do you know which is best then? My rule of thumb is: “If you have sharp or burning pain or pain that is greater than 5/10 on the pain scale, USE ICE. If you have
mild to moderate pain that is achy, USE HEAT.” Also, never sleep with a hot pad all night.
Another common question I get is, “How soon should I come in for treatment after I hurt myself.” This is particularly concerning if you have a severe amount of pain. Our research with whiplash here in the clinic has repeatedly shown that those who seek treatment the soonest have a faster recovery time. What many patients don’t realize is that we have many treatment tools at our disposal and will typically use gentle procedures during the early acute phase of injury. Mobilization, stretching and gentle traction are usually much more effective than manual adjustments at this point in recovery.
Clinical research on acute back pain supports the idea that an early return to normal activities speeds up recovery. However, if it hurts too much to do any activity then early treatment to reduce the initial pain is essential. Otherwise, you get more “stoved up” because you are avoiding movement or moving too fast. This further irritates your nerves resulting in even more muscle spasm.
So the next time you hurt yourself, reach for the ice pack first – you can always switch to heat if it doesn’t seem to help. Secondly, if you really dinged yourself up, don’t wait so long to come in. It is easier to fix right away and usually go away faster with early treatment. An old chiropractic teacher used to say the five most dangerous words he heard in practice were,” Maybe it will just go away!” There is good wisdom, don’t you think!