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Should I Use Heat or Ice for Pain?

Ankle treated with ice

Should you use heat or ice on your painful injury? The best method of solving this important riddle is to assess the nature and source of the pain. Essentially, a new injury, that is, one that you sustained within the last 48 hours, is best treated with ice. Chronic pain, or pain that you have had for a long time, is generally best treated with moist heat. Understanding the mechanisms of injury and the physiological and biochemical causes of pain helps us to differentiate the indications for applying ice or applying moist heat.

The primary rule is that you can never go wrong with applying ice. Ice calms things down and, although an ice application may be uncomfortably cold for a few moments, the overall effect is soothing. Cold decreases local metabolism and constricts small blood vessels (arterioles). Cold reduces nerve conduction velocity, that is, the speed at which nerve impulses are transmitted, and therefore reduces the number of pain signals that reach your brain per unit time. Thus, ice applications provide vasoconstriction, analgesia, and sedation. Ice is indicated for acute musculoskeletal injury, burns, insect bites, bleeding, and snake bites. Ice should not be used for gout, rheumatoid arthritis, Raynaud's phenomenon, history of vascular impairment, and cold allergies. As well, ice should not be used for a patient in a coma.

Moist heat increases local metabolism and dilates small blood vessels. Vasodilation results in increased nutrition, increased activity of white blood cells (phagocytosis), and increased removal of waste (metabolic end-products and damaged cellular structures). Moist heat provides analgesia, sedation, and reduces muscle spasms. Heat is best for chronic pain and muscle spasms. Contraindications to moist heat include acute musculoskeletal injury, area of diminished sensation, acute skin conditions, pregnancy, malignancy, diabetes, encapsulated swelling, hemorrhagic disorders, and suppurative conditions.

Generally, ice applications are used for acute injuries within a 72-hour time frame from the onset of the injury. Acute injury damages local capillaries, causing blood to leak into the spaces between cells and tissues, where it doesn't belong. Such uncontained blood causes pressure on local nerve endings, creating pain. Also, pressure is applied to nearby cells, causing extended injury and possibly cell death. Thus, limiting the amount of blood leaking out of disrupted capillaries is critical in slowing the effects and reducing the impact of musculoskeletal injury. Ice performs this function. Ice reduces swelling, reduces pain, and provides a sedative effect.

When applying ice, it's very important to avoid damaging the skin. Ice packs should always be wrapped in a towel. Ice should rarely be applied directly to the skin. Duration and frequency of ice applications is not an exact science, but a useful guideline is to apply ice for 15 minutes every two hours for a moderately acute injury, using three to four ice applications per day. However, you will know instinctively when the time is right to apply the next ice pack.

Moist heat applications follow similar guidelines. Dry heat should never be used. Moist heat packs should be wrapped in a towel and are applied for 15 minutes every two to three hours, up to several applications per day.

Recovering from injury requires your body to put forth a great deal of effort and requires support from the nerve system, the body's master system. Regular chiropractic care provides great assistance in the process of recovery from any injury. By detecting and correcting spinal misalignments and sources of nerve interference, regular chiropractic care helps ensure optimal functioning of the nerve system. Thus, regular chiropractic care helps facilitate your recovery and helps you return to your full range of activities as quickly as possible.

1McCarberg B, D'Arcy Y: Options in topical therapies in the management of patients with acute pain. Postgrad Med 125(4 Suppl 1):19-24, 2013

2Piana LE, et al: The Cold, Hard Facts of Cryotherapy in Orthopedics. Am J Orthop (Belle Mead NJ) 2018 Sep;47(9). doi: 10.12788/ajo.2018.0075

3Mayer JM, Mooney V: Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil 87(10):1310-1317, 2006


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Testimonials

  • "I have been a patient at Dr. Meylor’s clinic for the past 15 years, and during that time, he has been my primary health specialist. As an elite age group runner, it is extremely important to stay in alignment – both to prevent injury and to sustain optimum performance, so it is crucial to get a chiropractic adjustment at least once a month. Along with proper training, orthotics, attention to nutrition, and adequate sleep, chiropractic has been an essential part of my success in which I have been fortunate to compete at a national level in my age group for many years. And at a time when many of my age group competitors are declining in their running abilities, I have been able to improve my performance based upon age grading scales and have even been listed nationally in USA Track & Field’s rankings over the past two years. I am convinced this wouldn’t have happened had I not been getting regular adjustments from Dr. Meylor."
    Andriette Wickstrom, Storm Lake
  • "In addition to adjustments, there have been several occasions in which I have had non-invasive acupuncture treatments, with very successful results, especially during several instances in which I experienced severe headaches from allergic reactions. Not only did the acupuncture alleviate the pain, it also convinced me to never attempt to mask such problems by using aspirin or other such drugs or pain relievers."
    Andriette Wickstrom, Storm Lake
  • "I realize that not everyone is a competitive athlete, however, being in the best physical condition possible should be a goal for all of us as we strive to lead happy and productive lives. I greatly recommend having chiropractic care as an integral part of everyone’s health plan. The high quality care I have received from Dr. Meylor has contributed to my overall excellent health, and I would encourage others to maximize their own physical potential by choosing chiropractic treatment. Not only does Dr. Meylor offer exceptional skills, he is also very approachable in communicating to patients using understandable terms, and I completely trust his professional expertise."
    Andriette Wickstrom, Storm Lake
  • "I was diagnosed with Fibromylagia 9 years ago, after being in bed for 6 week's due to the severe pain I was in. A friend recommended that i go to see Dr. Meylor. When i first walked into Dr. Meylor's office I was struggling to hold my head up without support. Dr. Meylor suggested therapy, acupuncture, an alignment, proper nutrition and exercise. The combination has kept me moving.
    Dr. Meylor sees me once every 3-4 week's Keeping aligned has proved to give me the best relief from my fibromyalgia symptoms. Thanks to Dr. Meylor and his staff, over the course of the past 9 years I have been able to have a very good quality of life with fibromyalgia.....something I once thought I would never have."
    Chandra Younie
  • "I came to see Dr Meylor with constant burning in my ear, down my neck and arm. The office staff made me feel so welcome. Dr. Meylor examined me and i was adjusted twice that week and I felt so much better with each adjustment. I know that with my stressful job I will feel and do better to keep myself adjusted and continue going to Dr. Meylor on a monthly basis. Best decision I ever made."
    Rebecca
  • "I first started see Dr. Meylor in November 2012. When I first came to the office I was unable to walk for more than 1 block and I was not able to stand for more than five minutes. I was in such severe pain with my lower back that I had opted to seek pain control through the use of pain medication shots put directly into my spine . After a series of a total 12 shots into my spine I was still in severe pain and no relief in sight."
  • "Upon Dr. Meylor's recommendation I started seeing him 3 times a week for 4 weeks then 2 times a week for 3 weeks and finally 1 time a week for 2 more weeks. I was finally able to cope with what little discomfort I had. I now am able to stand for a good portion of my day and I can now walk about 8 block now without much pain. I will never be free from my back issue but I am now able to return to a normal life. I owe a lot to Dr. Meylor for helping me to become stronger and more functional in my day to day living. I continue to see Dr. Meylor on a weekly basis and am so happy with my improvement. I would highly recommend him to anyone that is needing help with any kind of chiropractic need."
  • "I had been suffering with severe low back pain and sciatica down my left leg for months. This affected everything I did and I became less and less active. I could not sleep at all at night because of the pain. My family could see how much pain I was in and I was not myself. I had to stop going to my children's school and sporting events that required me to sit in bleachers because of the constant pain.
    I went to my MD several times and was given pain pills and muscle relaxers. They made me feel terrible and now I had more side affects from them. The Dr. told me I should have back surgery which scared me to death."
  • "A friend told me to try her chiropractor Dr. Meylor. I called and they got me in that same day. Dr. Meylor listened to all my complaints and did a thorough exam and x-rays. He explained why I was experiencing this kind of reoccurring pain and what he could do to help. I was adjusted that day and given therapy. I felt immediate relief after my adjustment. I could'nt believe it! I had two more adjustments that week and I was so excited to be having less pain and I started sleeping thru the night! I continued following Dr. Meylor's recommendations and I feel great now and truly have my life back! I have my friend to thank for recommending Dr. Meylor and I have told many friends about my experience!"