To Heat or not to Heat? That is the Question..

I have this question asked every week, so here we go. The answer is not black and white so let me give you four guidelines to help you determine whether to use heat or ice on your pain.

1. If you can see the bruise, use ice.

If you have just injured yourself and the bruising is visible, use ice! Say you rolled your ankle and it is swelling, or you felt your calf or hamstring ‘pop’ and a bruise is emerging, use ice. Simple rule: If the bruising or swelling is visible use ice for the first 48 hours for 10-15 minutes every few hours.

2. If heat makes the pain worse don’t use it!

This might sound really obvious, but, well, you would be surprised. Call it the common sense rule. For example heat might normally work well for your headaches but today the heat seems to make it worse. This means you have a different kind of headache to your normal headaches. Don’t persist with the heat. Another example is nerve pain. Nerve pain will hate heat, it will let you know immediately: ‘Get off! Get off!’

If in doubt use heat as a trial.

If there is no visible bruising then trial heat for 15 minutes. If it feels worse you may have nerve pain or a vascular migraine. Don’t fear, using the heat briefly as an experiment will not make the condition worse, but it will provide helpful information for your GP or therapist if you decide to see them at some point.

3. If it feels good use it regularly for three days.

If your pain is primarily muscular in origin then using heat for 15 minutes, two or three times a day for three days will improve or resolve your pain. I say 15 minutes deliberately. Heat causes increased blood flow which promotes healing, however after about 15 minutes the body decides there is too much blood going to that area and restricts blood flow. As such, longer is not better but 15 minutes several times a day is best.

4. If your pain is not noticeably better after three days, get some treatment.

This is where it gets confusing. Often pain and stiffness is due to a new or old joint injury. Let’s use the neck as an example. An injury in a spinal joint in the neck will attract inflammation however this joint inflammation may not hurt. Instead the muscles in the neck will stiffen to assist. Now your pain and stiffness is caused by the muscles but they are simply the messenger – not the real problem. Heat will relax the muscles and give relief so you think the heat is working. But three days on and no better? The reason is that the joint irritation under the muscles is the real problem. Talk to a professional.

So in conclusion, I tell patients: ‘If there is no obvious bruising then try heat, if it hurts more don’t use it and even if the heat gives you temporary relief, if you’re still the same three days on then seek treatment.’

Hope this helps!

– Timothy King | Myotherapist