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Ask the Doctor: Heat or Ice?

What is the best thing to use when you're in pain? Heat or ice?

This week's question came from Alyssa:

I have some achy muscles and some low back pain occasionally. What is the best thing to use: heat or ice?

Thanks for the question this week!  

Well, the 'text book' usage of ice is in any case of acute injury (such as ankle sprain or whiplash) for the first 48-72 hours. Heat can be applied to any chronic pain after that initial 72-96 hours has passed. 

Usually with an acute injury, you also have swelling, pain, and bruising or redness around the area. Sometimes when you have a lot of inflammation, the area can also feel warm to the touch. When these symptoms are present, it's definitely an indication for ice. I usually don't follow the textbook rules of 48-72 hours because people aren't textbook at all. 

I have had some patients with low back pain, knee pain, or neck pain with swelling well after that 72 hours. Especially with some of the extremity joints (knees, ankles, elbows), sometimes the edema (fluid) can take a little while to go down. The older a person is, certain medical conditions, activity/exercise, and severity of the trauma will also influence any inflammation.

Ice works to constrict the blood vessels, reducing the swelling in the area. I usually tell people to ice 10-15 minutes at a time (usually less if it's a hand or foot that needs to be iced), making sure you have at least one layer between the skin and the cold source. I also advise people to not lay down on top of ice and if the area starts to get numb, that's a pretty good indication to stop icing. 

So, heat can be applied to those stiff and achy muscles. Heat works by dilating the blood vessels, bringing extra blood and oxygen to the area which can reduce muscle spasm. Some tips for using heat are the same as ice: 10-15 minutes with a layer between the skin and heat source. If it feels like it's burning, time to stop. You want to make sure there are no signs of inflammation when applying heat as this can actually make it worse.

It is also possible to over-ice or over-heat, so unless someone is really severe, two to three times a day is good for most people. If anyone is ever unsure of what to do or for how much, I'm always happy to answer questions directly at my office so that we can assess exactly what's going on. You can also contact your medical doctor. As with many health questions, it's best to ask a health professional directly and get an assessment. The heat and icing tips I listed above are just simple guidelines to follow. Age, activity or exercise levels, injuries (past or present), and medical conditions are all important to factor in when deciding which is best for each individual.

Thanks for the question and thanks for reading! If you have a question you'd like featured next week, please email me directly at QureshiDC@gmail.com.

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