In this video I’m talking about the when to use heat or ice for joint pain. A lot of patients ask me which one’s right for them and there’s actually a fairly straightforward answer.
What do heat and ice do?
Heat dilates the blood vessels in your body and creates more blood flow to the area. This increases the elasticity of the tissue because there's more hydration of those tissues, so they can stretch a little bit more before you cause trauma. Heat is generally good before doing an activity or to loosen something up.
Ice has the opposite effect. It constricts the blood vessels and restricts the amount of blood that flows to an area. If you're having an inflammatory response, ice is good to keep inflammatory agents from getting to the tissues involved, so you don't further that inflammation.
Which one to use?
Very simply put, I tell people to use heat before an activity and ice after, if needed. Or heat if you're stiff, ice if you're sore.
Now, there's a little more nuance than that.
One of them is that there is a debate amongst certain therapy circles about how much heat and ice actually do. Your body is really good at controlling its internal temperature, and so external heat and ice sources aren't really going to permeate deeply into your body.
You may have been told by another practitioner that heat and ice don't really do a lot for your back or if you pull the hamstring because of this belief that the energy won't get that deep into that tissue. This has created some confusion in my practice before when I tell people “heat when you're stiff, ice when you’re sore”.
The other thing is that I don't always heat or ice people, mainly because of the physiological process that's involved. Heat will also take you out of a guarded sympathetic state, which means that if you've got a high tone signal to your muscles because something is sore or injured, your muscles are going to be very tight, which isn't going to allow you to move normally as you are supposed to. If you put a heat source on it – even if it's something like a deep structure, like something in your back – that can still help everything feel better because it's taking you out of that sympathetic nervous state, getting that guarding response on getting that muscle tone down and relaxing everything out. So there's a neurological process that's involved with heat and ice as well.
If you're very sore, ice is also a topical analgesic. So, if you're very actively acutely inflamed and sore and you put an ice pack on it, that's going to numb it out.
And what I always tell my patients is that if you feel better, you'll move better. And if you move better, your body is going to be able to adapt and heal better.
Do what feels best
At the end of the day, what I always tell my patients is that they should do what feels best.
It is still important that you’re aware of certain precautions. You don't want to have an ice pack that's too cold on your skin for too long if you have any kind of nerve issues. Keep checking your skin to make sure you're not creating any tissue trauma that you're not aware of because say your fingers are numb. But outside of that, if something is feeling good, keep doing that because most likely it's going to allow you to move better and do the things you want to do.
So, the very simple answer for this very long-winded explanation as to whether to heat or ice is “heat when you’re stiff, ice when your sore” or “heat before, ice after”, and an even simpler explanation is, do whatever feels best.
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