Pain has a personality. It can be dull and achy, sharp, electrical, or burning. It may come and go or be present all of the time. Some pain feels better with pressure or massage, and some doesn’t like being touched at all. Your pain may feel better when you apply heat, or it may respond better when you put an ice pack on it. As a practitioner of acupuncture and Chinese medicine, my job is to diagnose your pain based on its personality.
One of the most common questions that I get from patients who are dealing with pain is whether they should put ice or heat on the painful area. While it would be great to have a simple answer, there are a number of considerations in deciding between a heating pad and a bag of frozen corn.
First, it’s important to know whether your pain or injury feels better when it’s exposed to warmth or cold. For example, is it worse during the hot and humid days of summer or when the weather turns cold? Does your injury feel warm to the touch? When you’re trying to alleviate the pain, is your instinct to reach for a heating pad or an ice pack? In general, injuries that feel better with cold involve some kind of a warm pathology. For example, heat rising upward in your body can give you a headache that you just naturally want to put ice on—this is common with many migraines. In contrast, many injuries involving a pulled muscle heal faster and feel better when heat is applied. This is also true for arthritis and many joint injuries.
Second, the properties of heat and ice are helpful in determining which to use. In Chinese medicine, heat creates and enhances movement. In an injured area, blood, fluids, and energy will flow better when heat is applied. This means that muscles tend to loosen up, your range of motion increases, circulation in the area improves, and that boost in circulation promotes healing.
In contrast, ice contracts. Like a river that freezes up during the winter, ice constricts your vessels, tightens muscles, and slows things down in general. Despite this constrictive effect, ice has a place in many instances. For example, when you sprain your ankle, the damage to the ligaments and surrounding tissues make your foot and ankle swell up like a balloon. In fact, it’s this swelling that accounts for much of the pain associated with a sprained ankle. When you apply ice immediately after the injury, the constricting effect actually limits the amount of swelling in the area, making it a bit less painful, and much less swollen.
So when should you use heat and when should you use cold?
Here are a few guidelines:
For new injuries, especially those that have occurred due to trauma (sprained ankle, blown out knee), use ice for the first 24 to 36 hours after the injury has occurred. Ice will constrict the vessels in the area and keep swelling to a minimum. After 36 hours, apply ice if there’s still discernible heat or swelling, otherwise alternate heat and cold. If your injury lingers for weeks, my advice is to use heat.
The choice between icing and heating becomes a little trickier with inflammation. In general inflammation is considered to be warm, so conventional wisdom would be to put ice on it. But not so fast, because heat increases the flow of blood to an area, and increased circulation promotes healing. Again, my advice is to warm it up, or to alternate between ice and heat.
A good rule in general is to go with what feels the best on an injury. If you’re not sure, let the weather be your guide. Is your pain worse in the cold weather? Then use heat. If it flares in the summer heat, go for the ice.
That said, don’t be deceived by the numbing properties of an ice pack. You may feel better for a while after icing, but if applying cold makes it worse in the long run, use heat or alternate between the two.
Put your hand on the injured area. What do you feel? If it’s noticeably colder than the surrounding tissue, it means that the circulation in that area is constricted and you should apply heat. If your injury feels warm to the touch, apply ice.
In the case of a muscle spasm, avoid ice, as it will only make things worse. Remember that cold contracts, and if your muscle is in spasm, it is already contracted to the point of pain. How can you tell if you are having a muscle spasm? In most cases the pain from muscle spasms come on very quickly—many have an initiating event, such as lifting or reaching and twisting at the same time. In addition, muscle spasms tend to inhibit your ability to move, and many will have you on the floor because the pain is so intense. A high proportion of back pain is caused by muscles that are in spasm.
For sports-related injuries, exercises prescribed by a physical therapist, or if you’re just doing a workout that involves the injured area, my advice is to warm it up for five or ten minutes before using it. This increases the circulation to the area and loosens up the muscles that you will be using. After your activity, ice the area for five minutes to cool it off and head off any inflammation.
There is no hard and fast rule for whether to use heat or ice. In Chinese medicine, the tendency is to heat in the majority of instances. However, there are times when icing is appropriate. The bottom line is that you need to take into account the personality of the pain, the nature of the injury, and how long you’ve had it when deciding whether heating or icing is the best course of action.