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Ouch! When you have pain, whether in the neck, back, ankle or nose, what do you do? Ice or Heat?

As a licensed massage therapist I get this question a lot. Especially when ones have been in a car accident or a slip and fall at work. Many have been taught the philosophy to ice for 24hrs, heat for 24hrs, or something similar. Were exactly that came from, I’m not sure, because it is NOT founded in science. The facts of the matter that we need to discuss and understand is what happens after you hurt yourself… A Pain response will illicit your brain to increase blood flood to help in the repairing process. This much need “new” blood is essential to repairing the muscles that have been damaged. The break down happens when either this response does not turn off or if the blood flow increase has no exit due to scare tissue. This is what we call inflammation. Putting heat on an area that is already warm will only sooth the pain temporarily due to the nerves getting overly stimulated. In the end, heat will only act to increase the blood flow to an area that already is getting too much. So besides getting a massage to help alleviate the blockage in the muscle, we need to SLOW down blood flow. By applying ICE, yes ICE, to an area will decrease the blood flow by restricting the blood vessels themselves. Now this is where timing is everything. Because if ice is left on an area for more than 20 minutes the opposite effect kicks in. This is a fail safe response from your brain fearing hypothermia and death. After this golden 15-20 mins has elapsed, your brain will then increase blood flow (heat) to stop the tissues from dying. This is ultimately why it is completely unnecessary to heat after ice! Your body is already almost 100 degrees! Once the tissue has decreased the blood flow, it has allowed the area a chance to reestablish a normal blood flow ammount to bring in the “new and fresh” and exit the “old and damaged” cells. So ICE for 15-20 minutes, yes even if it winter outside. You will thank me later when your recovery time is cut in half!

Written by Jamin Rak

Therapeutic Massage Therapist located in Portland, OR Specializing in: Acute and Chronic Pain including Car Accident Recovery. State of Oregon License #6827 BCMTB #2001062 Licensed since 1999. https://plus.google.com/+jaminrak

4 Comments to “Ouch! When you have pain, whether in the neck, back, ankle or nose, what do you do? Ice or Heat?”

  1. Alicia says:

    My school taught the you can do either just ice or alternate ice w/ heat for new injuries. But you do heal quicker when you alternate the two w/ 20 min on 20 min off for a new injury & the opposite for an old one. It worked pretty good when I sprained my ankle although alternating the two can be a pain in the rear. Also remember ICE & that you should always wait 4-5 days after a neck injury after the entire injury presents itself.

    • While I appreciate that many have been taught the alternating ICE/HEAT ON/OFF philosophy, but its actually contraindicated by medical science. Here is a fine article about the benefits of ICE and when, if ever, HEAT can be used. HEAT should NEVER be used after an injury, this will only increase the inflammatory response and make matters worse for the patient. Thank you for your comment.

  2. JM says:

    This is not a great article. And the comments are not great either:
    Yes, you do want to ice for 24 hours after an injury–no more than 15-20 minutes at time, 45 minutes to an hour between–while awake, no need to do it overnight (unless you want to or are having trouble sleeping due to pain). After that, if you still have swelling, you want to do either cold or alternate cold and heat to stimulate the lymphatic pump. If there’s no swelling, you can choose whichever feels better–though you should use heat for joint stiffness.

    • Thank you for your feedback, but what exactly do you not like about the article? You seem to agree with the post… but where do you come up with the 24 hours remark? Does inflammation magically disappear at the stroke of midnight? Inflammation is an ongoing process, especially after a significant injury to the tissues. While it persists, one must use ice, not heat.

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