The Heat or Ice Conundrum

Should I heat it or ice it? I hear this question frequently in my massage work, and I wish it was easier to answer.

For years, the loose guidance has been ‘ice for immediate injury, heat for achiness and improved mobility.’

There are some nuances to consider. And in true nerd fashion, I think it’ll be fun to look at the history a bit.

In 1978 Dr. Gabe Mirkin created and included ‘RICE’ in his sports medicine book as a treatment for soft tissue injuries. Rest, Ice, Compression, Elevation. The idea was to reduce inflammation that can increase pain and slow down healing. It was logical, it seemed to work, so the sports world grabbed hold, and medicine soon followed.

Since then, Dr. Mirkin has reversed his support for the RICE method, based on a large number of studies that showed no or mediocre results. We know know swelling and inflammation are not the same thing, and they don’t necessarily correlate to healing time.

So, with the RICE protocol out the window, how do we make this decision?

First and foremost, do what is comfortable for you. If you hate being chilly, ice is a terrible idea. If you are always warm and uncomfortable, do not cover yourself in a giant heating pad.

Next, consider what ice or heat does overall. For many people ice, or just cold, can kick up the nervous system and make the body feel like it’s in danger. Whereas heat, especially in the form of a weighted heating pad, can be really calming and relaxing to the whole body.

With all that in mind, here is my very general stance on Heat versus Ice:

If you have seen a physician, physical therapist, or any kind of medical provider for this issue, do what they suggest. If their approach is uncomfortable or you feel like it makes you worse, talk to them for more guidance.

If you are DIY-ing your care for something minor, I suggest ice very soon after what you feel is an ‘injury’. If you were doing something strenuous and heard a pop, can feel a tender spot, and the area looks a little puffy, go for the cold. Use ice, on for 20 minutes once an hour or so, and be sure to have a protective barrier between your skin and the ice or cold pack.

A cold pack on the head or a cold mask on the face may be temporarily helpful if you have a headache or discomfort from stuffy sinuses.

For stiffness, general or deep achiness, and simply feeling muscular tension (“tightness”), heat usually feels great. Heat with some weight behind it (like a heating pad or hot pack with some heft to it), I’ve found to feel calming to the whole body and helpful in encouraging everything to ‘unclench’ and let go.

Tension headaches are often relieved with heat to the shoulders and neck. For migraine sufferers, use whatever feels best for you.

As you can see, there’s quite a bit of gray area and a considerable amount of trial and error. Reach out if you have questions or want to try massage along with your DIY approach!

Here are some additional resources, if you’d like more information:

Ice versus Heat for Pain and Injury

https://www.painscience.com/articles/ice-heat-confusion.php

Here’s How to Choose Between Using Ice or Heat for Pain

https://health.clevelandclinic.org/should-you-use-ice-or-heat-for-pain-infographic/

Wikipedia

https://en.wikipedia.org/wiki/RICE_(medicine)#:~:text=RICE%20is%20a%20mnemonic%20acronym,by%20Gabe%20Mirkin%20in%201978

The R.I.C.E Protocol is a MYTH: A Review and Recommendations

https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/