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There are four options when thinking about whether to heat an area or ice it:

  1. Heat
  2. Ice
  3. Alternate heat and ice
  4. Do nothing.

People wonder and worry about this question. I'm often asked what the correct protocols are.

The short answer: do whatever seems to help. Don't sweat it, it's not heart surgery.

While doing the right thing can help the healing along, doing the wrong thing once or twice, or even a few times, isn't going to cause any problems. Nonetheless, here's some useful information.

The slightly less short answer: if it's swelling up, ice it down. If the swelling is receding, alternate heat and ice. If it's sore but not swollen, heat it up.

Let's start with the effects of ice.

  1. Constricts local blood vessels and decreases circulation to the area. This obviously helps if there is internal bleeding, or actively increasing swelling or bruising.
  2. Numbs nerve endings and blocks pain.
  3. Decreases the metabolism of the cells which it contacts, which causes muscles to relax and inflammatory cells to slow down.
  4. These effects penetrate about 1/2 inch, and are only in effect for as long as the ice is applied.

Decreasing circulation is counterproductive when the tissues are trying to heal. Tissues need blood, which carry nutrients, oxygen, new cells and building blocks for new tissue. So don't ice it if your trying to rehab unless you've just done some aggressive rehab work and the region is swollen. Then ice for a couple of days. A lot of rehab is controlled reinjury, and for that, ice is good.

Now, the effects of heat.

  1. Causes local blood vessels to expand and increases circulation to the area. This helps by bringing fresh blood and nutrients to the sore area.
  2. Gives nerve endings something else to pay attention to, thereby decreasing pain.
  3. Softens tissue.
  4. Has a general relaxation effect on the body.
  5. By virtue of #3 and 4, relaxes muscles.
  6. Increases the metabolism of the cells which it contacts, which can speed up healing.
  7. These effects penetrate about 1/2 inch and continue to be in effect for about 15 minutes after the heat is removed.

Increasing circulation and softening tissue is helpful when they have been overworked but not injured (sore but not swollen). These are also helpful when the joint is degenerated and the cartilage has gotten hard and dry (arthritis). However, you don't want to heat up a swollen area, as you'll cause stagnation of the swollen fluid, causing it to congeal, and that makes it harder to get rid of.

Alternating heat and ice is a great option.

By going back and forth, you get the best of both worlds. The blood vessels expand-and-contract, giving you a bit of a pumping action to the local circulation. This helps flush the region and keeps things from stagnating. Five minutes of ice followed by three minutes of heat. Back and forth at least three times. Start and end with ice.

Doing nothing really isn't a good option.

Questions? Need clarification? Want to argue the point with me? Call me or drop me a line via email. I always welcome you!