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If only I knew…
...That I Should Have Iced it.

marie catherine bruno owner of the sole mate

A friendly medical chronicle

By Marie-Catherine Bruno, BScPT, Cped(C).

I just pulled my hamstrings. Should I use ice or heat?...
I sprained my ankle 2 weeks ago…my friends tell me I should now use heat…What should I do?

Many of you still wonder! And to be honest, many of the health professionals still do not have a straight answer for you. The studies over the years have been slightly contradictory, so it is not rare to hear a younger health professional give you a different advice than an older one. My opinion on that: listen to the young one!
But anyway, here are the major effects associated with the application of deep ice and heat, according to the latest studies. They should help you make an educated decision next time you are in pain!

Ice Reduces: 

  • Circulation (blood flow), therefore helps stopping the bleeding and reduces the swelling;
  • Nerve conduction, which decreases the pain perception (in your brain);
  • Your metabolism, so reduces the natural inflammatory process (in other words, ice is a natural anti-inflammatory);
  • Muscle elasticity: muscle fibres bathe in a fluid called the interstitial fluid. When cooled down by ice, this liquid thickens up and the fibres cannot slide as easily against each other, therefore you lose some elasticity;
  • Proprioception: because the nerve conduction is slowed down by the ice, your ligaments cannot react as fast, and therefore your reflexes and balance reactions are not as quick.;
  • Muscle spasms: again because the nerve conduction is slowed down, so are your reflexes. Muscle spasms are a reflexive protective mechanisms, so there you go!

Heat Increases:

  • Blood circulation, therefore may increase the bleeding and the swelling;
  • Metabolism, so may increase the inflammation process or any bacterial/viral attack;
  • Sedative effect: temporarily decreases the pain and helps relaxing. This effect stops the minute you take the heat away;
  • Muscle elasticity: helps improving the muscle plasticity and flexibility before a stretching session (see elasticity above), by warming up the interstitial fluid;
  • Synovial fluid thickness: your joints are filled with a fluid called synovial fluid. When warmed up, it becomes thinner and easier to move around so that your joints feel looser.

So in other words, on a fresh injury, it seems pretty obvious that ice is the way to go. Where it becomes ambiguous is with older injuries (the chronic type). In physiotherapy, heat is only used in a few cases:

  • Before a stretching session or a massage, to help improve the malleability of the muscle;
  • On some scar or old injury, where adhesions or scar tissue need to be broken down;
  • Before range of motion exercise in the case of inflammatory joint diseases or stiff joints (like rheumatoid arthritis, osteo arthritis, Lupus…), but only when the patient is not in a flare up.


So unless your condition corresponds to one of the above, you are probably still better off with ice. One thing you have to keep in mind though, is that because ice also affects the nerve conduction (decreases its speed) and makes your muscles stiffer, you do not want to ice before you exercise. You have to give yourself a good hour or two to thaw before you go out and exercise. Otherwise, you may end up with a muscle rupture or a bad sprain (but hey, at least you will know that you have to ice it now!!!).

How to play with ice and heat!

So now that you know which one to use, how do you apply it, and for how long?

Deep ice: your best option is still the good old frozen peas (or corn!). The bag will not leak, and because they are very small, they mould to the area really well. Forget about the Magic Bag (cereal bags) that you can also microwave for heat; it never gets cold enough. Be careful with ice packs. The really hard ones can cause frost bites, and they do not mould the area well anyway. The soft ones (usually silicon or some other gel) are good but more expensive than frozen peas!

You also want to apply wet ice. So simply wrap your ice pack or bag in a very very thin wet towel. The cold will penetrate deeper and will make its way through the skin much easier, bringing the risks of frost bites close to zero.

Apply to the area for a good 15 minutes, unless the injury is very superficial (like a burn), in which case 10 minutes will do. If you think it is a very deep muscle, you can go up to 20 minutes.

Repeat the process as often as you can, ideally every 2 hours.

Note: old studies used to claim that if you applied ice for too long, you were starting to provoke the opposite effect in your body and it was as bad as applying heat on a burn! Recent studies now show that this reaction only affects your skin. So unless you have a burn, you don’t have to worry about icing it for too long.

Ice massage: it is a good way to reduce the pain before you exercise. Because you are not deep icing, the risks of injury as stated above are well diminished. All it does is reduce the circulation in your skin, but also, and more important, decrease the sensitivity of the nerve endings, therefore reducing the pain in the area. So if there is an event you absolutely need to take part of, this can be a way of making it a bit more enjoyable!

The ideal way of doing it is to freeze a plastic or foam cup (you know those disposable party glasses!) containing water. When you need it, you just peel the bottom off, and that way you don’t freeze your fingers when massaging!

Massage the area for 8-15 minutes. The skin will turn pink, but should not turn red (if it does, you are starting to deep ice – not good). Do as close as possible to your event (just before the start if possible), because the effect does not last very long (about half an hour).

Remember though: this is not a way to make you heal faster, it is just a way to cover up the pain.

Hot packs: the ideal hot pack is the Magic Bag or any bag of cereal that you can microwave. It is quick, and it gives out moist heat, which just like ice, will penetrate deeper than dry heat. If you have the type that you fill with boiling water, then just wrap it in a wet towel – you will get that same moist heat effect. If you are using an electric pad, forget about the wet towel, unless you want to commit suicide!

Leave on for a good 20 minutes. Make sure you do not burn yourself, so please avoid sitting on or lying down over a hot pack. Make sure that the hot pack is resting on you, and not the opposite.

Hot tubs and warm paraffin: you may get sedative and relaxing effects from a hot tub, but usually because your whole body is in it, you cannot bring the temperature high enough to get the muscular or joint effects described above. The ones used in therapy are designed so that only the affected limb lies in it, therefore the temperature can be much higher.

Warm paraffin can also be used for small joints (like fingers and toes). You can make your own paraffin bath at home, by mixing mineral oil and paraffin, about 1/3 for 2/3. Again, test the temperature before dipping your fingers into it!

Contrast bath: very radical but highly effective way of reducing the swelling. Ideal for stubborn edema. The trick is to play with the opening and the closing of your blood vessels (called vasodilation and vasoconstriction) to create a pumping effect in your limb. This will highly activate your circulation and help eliminate the swelling.

Take 2 containers big enough to immerse the area (usually hand or foot), and fill one with warm water, and the other one with ice cold water. Start in the warm one. Dip for 30 seconds, then immediately plunge into the cold one. You will hate me, it will hurt! But it works! Leave in the cold for 1 minute. Repeat the process for 15 minutes, alternating heat and cold, always using the same ratio: 30 seconds for 1 minute. Finish in the cold. Then admire the result!

You should now have enough knowledge to answer the questions that got this month’s chronicle started! Once again, if you have more questions, do not hesitate to contact the editor. Now go out and spread the good news!!!