Injuries come in all different flavors. There are subluxations. There are muscle  spasms. There are muscle strains, tears, and trigger points. There are sprained ligaments and broken bones. So when having to deal with the pain that accompanies an injury, what should a person do? Aside from getting in to see a doctor—chiropractor, medical doctor, or emergency room—you can help your own cause with a little home care while you wait for your appointment (or en route to the hospital/doctor's office).
The question I am most often asked in my Los Angeles chiropractic practice is when would it be appropriate to ice an injury, and when should one use heat? The central component that must be kept in mind is what the mechanism of injury is. Was it a true injury? Did you fall, get hit by something, “pull” a muscle or twist an ankle while running or doing any other activity? Did you simply wake up with pain and stiffness that seems to be getting worse? These scenarios require that you either ice or heat, not both. True, some practitioners suggest doing both, but I don't and you'll see why shortly.
When to use ice
 If you've had an actual injury, perhaps something that I've mentioned above, or you've fallen down the stairs and landed on your hip (don't laugh, I've done it), you've taken a solid body-check to the ribs in a hockey game, or you've pulled your inner thigh playing with your Jack Russell Terrier, then you will definitely need ice. Ice is required whenever there might be an inflammation. Inflammation is heat and swelling of a tissue, be it a joint, muscle, ligament or tendon. Left unchecked, inflammation can cause scar tissue and degeneration.
So the idea is that whenever you have an injury, ice it immediately. Okay, you've got twenty-four hours, but understand that when it comes to icing, the sooner the better. You want to apply it to the injured area for fifteen minutes exactly, never directly on the skin (use a paper towel), and you absolutely must tough out ice's three stages. The three stages of ice are:
cold—the obvious one
-
burning—the stage that people usually remove the ice
-
numbness—where you eventually want to be
Applying ice to an injured area is called cryotherapy . Cryotherapy is a godsend whenever you suffer an injury. It will make the difference between an injury turning chronic and difficult to treat, and having no injury at all.
When to use heat
So, if ice is used to break inflammation, and the cardinal characteristics of inflammation are heat and swelling, then you can probably figure out that you don't want to put heat on an already hot area. That one mistake can lead to an increase in inflammation—very bad for the healing process. Worst of all is that you probably won't feel crummy right away, so you likely won't put two and two together. You'll probably just wonder why you are in so much pain the next day.
 Heat should be used when you feel stiff and tight, like you want to stretch out a muscle, yet stretching does no good. That's a heat issue; you definitely want heat under those circumstances. Heat relaxes muscle tissue. It brings blood into the area of muscular tightness, and blood carries chemicals which help the muscle fibers relax. Why do you think a Jacuzzi feels so good when you are stiff? The best form of heat is “wet heat”. Anybody who has been into my Los Angeles, Beverly Hills and West Hollywood chiropractic practice knows that I use the 160 degree hydrocollator packs. They are moist, they are hot, and they penetrate deeply. They get heat into the deeper layers of the muscle tissue in a way the electric heating pads just can't do. I'm not much of an advocate for electric heating pads You may as well just use an electric blanket—same thing.
When it comes to heat sources, this is my order of preference:
- Hydrocollator packs
- Jacuzzi
- Hot water bottle—yes, the ones from the drug store
- Hot shower
- Pug or cat
- Wife
- The Sun
- Electric heating pad
And that's it. Stiff, tight, achy muscles require heat: if you ice them when you need to use heat, they'll feel no better or even worse, simple as that.
Why not both heat and ice?
Some practitioners recommend alternating heat and ice. The rationale is that the heat will reduce spasms and the ice will take care of the inflammation. That's certainly true, but I'm very, very wary to heat an inflamed area. It's just not good practice. If you've iced, and brought the inflammation down, why heat again? If you have to choose between breaking the inflammation and reducing the spasms, I'd always go for inflammation control. It will get you farther in the long run.
But as I've said, some practitioners recommend alternating between the two. If you absolutely must mix and match, then just make sure to finish off with ice, so that you can break the self-induced inflammation before retiring for the evening. When neither ice nor heat will do
Although I'm discussing this topic as if ice or heat will solve all your painful problems, the fact is that you'll probably need some type of treatment for a full resolution. If your pain is due to a musculoskeletal condition, then ice or heat should help, for sure. If your pain is due to something organic, however—cancer, let's say, or gall stones or heart problems—then hot and cold will pretty much be useless. If you have unrelenting pain that doesn't get better with ice or heat, you'd better get it checked immediately. The best way to determine where to go is like this: if the pain is positional, is worse with sitting or standing, or occurs with movement, then go see a chiropractor. If you reside in Beverly Hills, Los Angeles, or West Hollywood, come see me.
If instead your pain is unrelenting, wakes you up at night, comes after you eat a meal, accompanies a fever, or you have an impending sense of doom, then you must visit your medical doctor or the emergency room immediately. If you have severe abdominal pain that doesn't get better over time, you might have appendicitis, and you'll need to go to the ER proto.
And if you have a subluxation—a locked up joint, then neither heat nor ice will have any lasting effect. Either one will feel good, as the hot or cold is on you, because subluxations cause both muscle spasms and inflammation. But the simple truth is that when a joint is stuck, the only thing that will relieve the pain is a good ol' fashioned chiropractic adjustment. Once the joint in question is adjusted, and movement returns, the spasms and the inflammation will decrease and ultimately they'll both go away.
So now you know. If you are having a musculoskeletal issue, and you are waiting to see your chiropractor, then you might be able to help the healing process by using ice or heat as an adjunctive therapy. Don't forget—ice is vital for an injury; and heat is for sore, achy, stiff muscles. That's the simple formula. If you are ever unsure, visit your local chiropractic office, especially a sports chiropractic practice in Beverly Hills, Los Angeles or West Hollywood, because that's where you'll find me…and I'll set you straight—with a chiropractic adjustment, heat, ice and all.
- September 30, 2008
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