Ice and heat treatments: When and how they should be used

Nov 25, 2018 Dr Zulfikar Bux

By Dr. Zulfikar Bux

Assistant Professor of Emergency Medicine
Heat and ice have been used for many years to treat pain and to reduce swelling, and many people have found them effective. More recently, studies have been done to investigate whether heat and ice really make a difference to healing and the results have been inconclusive.
In general, when used sensibly, they are safe treatments, which make people feel better and have some effect on pain levels and there are few harms associated with their use. I have decided to explain their use, since it’s a question that patients often ask.

HEAT
Heat is an effective and safe treatment for most aches and pains. It can be applied in the form of a wheat bag, heat pads, deep heat cream, hot water bottle or heat lamp. Heat causes the blood vessels to open wide. This brings more blood into the area to stimulate healing of damaged tissues. It has a direct soothing effect and helps to relieve pain and spasm. It can also ease stiffness by making the tissues more relaxed.
If heat is applied to the skin, it should not be hot; gentle warmth will be enough. If excessive heat is applied there is a risk of burns and scalds. A towel can be placed between the heat source and the skin for protection. The skin must be checked at regular intervals.
Heat should not be used on a new injury. It will increase bleeding under the skin around the injured area and may make the problem worse. The exception to this is new-onset low back strains. A lot of the pain in this case is caused by muscle spasm rather than tissue damage, so heat is often helpful. Heat is often helpful for the following types of pain:

• Aching muscles from over-exertion.
• Aching pains from fibromyalgia and other chronic pain conditions.
• Cramping or spasm pains such as period pains.

ICE
Ice has traditionally been used to treat soft tissue injuries where there is swelling. However, there is growing evidence which suggests that applying ice packs to most injuries does not contribute to recovery and may even prolong recovery. This is related to the fact that reducing the temperature at the site of an injury will delay the body’s response. This will delay healing.
In one study, some people who used ice said that it was helpful for managing pain, although this did not translate into a lower use of painkillers. Many people find that ice is helpful when used to manage pain in the short term.
With any sprain, strain or bruise there is some bleeding into the underlying tissues. This causes swelling and pain. Ice treatment may be used in both the immediate treatment of soft tissue injuries and in later rehabilitation.
During immediate treatment, the aim is to limit the body’s response to injury. Ice will:

• Reduce bleeding into the tissues.
• Prevent or reduce swelling (inflammation).
• Reduce muscle pain and spasm.
• Reduce pain by numbing the area and by limiting the effects of swelling.

These effects all help to prevent the area from becoming stiff, by reducing excess tissue fluid that gathers as a result of injury and inflammation.

HOW DO YOU MAKE ICE PACKS?
Ice packs can be made from ice cubes in a plastic bag or wet tea towel. Cold packs can also be bought from pharmacies. Some people use frozen vegetables, especially peas, as a form of ice pack. Take care when using ice and cold packs from a deep freeze, as they can cause ice burns quickly if used without care and proper protection. Ice packs should be given at five to ten minute intervals and no longer than 30 minutes. Leaving it for too long can cause burns or frostbite to the skin. Oil or Vaseline should be placed on the skin before applying ice. This will help decrease the potential for skin damage.

WHAT ARE SOME PRECAUTIONS WHEN USING HEAT AND ICE?
Do not use heat or cold packs:
• Over areas of skin that are in poor condition.
• Over areas of skin with poor sensation to heat or cold.
• Over areas of the body with known poor circulation.
• If you have diabetes.
• In the presence of infection.

Also, do not use ice packs on the left shoulder if you have a heart condition. Do not use ice packs around the front or side of the neck. Ice causes a longer-lasting effect on the circulation than heat. Also, the painkilling properties of ice are deeper and longer-lasting than heat. They can both be re-applied after an hour if needed. Just be careful to avoid damaging your skin.

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