So there is a LOT of debate and controversy on this topic. I am going to give you my advice and the logic & justification behind that advice so that you can make the best, most informed decision for you.
We can see people who have been in a LOT of pain and sometimes for a LONG time! Now constant pain can make people do strange things. There are many things you can do to help yourself when you are in pain.
So many people come in saying that they've tried everything for the pain, but that they do get some comfort from heat.
Hot baths, hot water bottles, creams, tiger balm, electric blanket to get some relief from the pain.
Now, I get it, and they're right, heat feels lovely, but it can make all that inflammation that's there worse.
(1.11) Everyone who is used to doing some kind of team sport or group exercise knows that if you sprain, strain, pull or otherwise damage something then the first thing that you want to do is R.I.C.E. Rest. Ice. Compression & Elevation.
For example, if you step off a curb wrong and twist your ankle and it swells up like a balloon, what are you going to put on it, heat or ice...??
Ice.
But why? What does the ice do..??
It brings the inflammation DOWN.
What do you think could happen to the amount of inflammation if you put heat on it?
It could INcrease.
The role of inflammation
(1:51) Now, as an important side note, inflammation has a bad rap. Inflammation is crazy important and forms some of the fundamental parts of the healing cascade. Without it, healing and repair wouldn't happen properly.
When you have a lot of inflammation, causing pain in one part of your body, taking painkillers/anti- inflammatories strongly decreases that inflammation and reduces pain.
It will also decrease all the other tiny little pockets of inflammation throughout your body that occur as a normal response, not to damage as such, but to the low-level wear and tear of day to day use. Wear and tear that needs repair.
Obviously we don't want areas with lots of inflammation, but we don't want to wipe it all out either. Like we said, inflammation plays a part in the processes that defend and repair the body. We're not aiming for ZERO inflammation levels. We're aiming for APPROPRIATE inflammation levels.
Painkillers and anti-inflammatories
(2:56) Painkillers/anti-inflammatories can be very helpful and appropriate to quickly reduce high levels of inflammation and reduce symptoms when used correctly in the short term, but long-term use can have side effects and so, at least in my opinion, in the majority of cases, using them should be a stepping stone to a more appropriate, long-term treatment strategy.
Heat vs. Ice
(3:24) Heat feels great in the short term, but can increase inflammation levels and make the problem persist longer than it needs to.
(3:39) Ice can help to reduce inflammation locally, where it is needed most, and without disrupting the useful, little inflammation pockets in the rest of your body. So my advice, I know heat feels nice, but when you have pain, stick with the tried and true Rest, Ice, Compression & Elevation.
Using an ice pack
Now, when using an ice pack you ideally want to use something that is malleable and will mould to the shape of the area you are using it on. That's why we tend to use something like a packet of frozen peas, but a proper gel-filled ice pack is better. I have had one patient use a packet of frozen potato faces. Apparently they don't work quite so well. Whatever you use, make sure you don't put it on bare skin. Wrap the ice pack up in a tea towel, pillowcase or an old T-shirt first, before putting it over the painful area or you will freeze the skin and make things worse.
The main rule for using an ice pack is little and often, and how long you put the ice pack on for at a time depends on the depth of the area.
(4:55) For more shallow or sensitive areas, like the neck, knees, elbows or ankles, about 5 minutes on, 25 minutes back in the freezer and repeat 3-4 times a day. Icing can be more effective if done at the end of the day, once you have finished stirring it up during the day. When using the ice pack on slightly deeper or less sensitive areas like shoulders, 10 minutes on, 20 minutes back in the freezer.
(5:13) Deep areas, like the low back, hips and pelvis, partly depend on your build; if you are small and slight and petite, 15 minutes on and 45 minutes back in the freezer. Big rugby players or anyone still clinging on to their winter coat can keep it on for a little longer, 20 minutes on, 40 minutes back in the freezer.
These times are guides and I recommend them as MAXIMUM times! No longer! It is very possible to over-ice and make things WORSE! If it gets too cold. Take it off. If you get to the maximum time and don't think it's cold enough, still take it off. Remember that cooling the area will also numb it slightly, skewing your perception of how cold it actually is. So when checking, place your hand over the area to feel how cold it is. That way will give you a much more accurate idea of how cold it has become.
Time and patience
(6:21) An important thing to remember is that using an ice pack isn't like using a heat pack or painkillers, which can usually make the area feel better very quickly. Unfortunately, using an ice pack is a lot more like taking a course of antibiotics. Take one, and it's not going to make any difference. But run the course and it can make a profound difference! And just like antibiotics, don't stop the course just because the symptoms have eased. Run the full course or it could come back!
When to use heat and ice
(6:54) Now, heat CAN be useful. If you wake up stiff and achy but not in pain, then heat can be useful to get the blood flowing and loosen things up. Just don't use it when there is lots of inflammation there. My recommendation would be, heat for morning stiffness ONLY! Not after being up for more than a few hours. And icing BEFORE bed can reduce the inflammation that has built up from you being active throughout the day, bring that inflammation down and stop things from stiffening up overnight anyway.
Like always, this advice is general and more to act as a reminder. For more specific advice, tailored to your current condition, just ask your Chiropractor.
If you have any questions then please get in contact with us via phone or email and we will do everything we can to give you the help you need.