PODCAST: When to Use Ice & When to Use Heat for Aches, Injuries & More

 ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster. 

TODD ACKERMAN: I'm Todd Ackerman, I'm a former medical reporter, currently an editor at Houston Methodist. 

ZACH: And Todd, when you get hurt, when you get injured, do you use ice or do you use heat?

TODD: Well, in the immediate hours after an injury, they’ve always emphasized doing ice. So, I have dutifully done that in the past. I don’t love ice. Ice is not my favorite thing in the world.

ZACH: Okay.

TODD: But I, you know, I do what they tell you to do.

ZACH: Who are “they?”

TODD: Medical advisors.

[Laughter]

Doctor Google.

ZACH: Yeah.

[Laughter]

TODD: How about you? What do you use?

ZACH: I don’t get hurt, Todd. So, I wouldn’t know.

TODD: Back when you were in your baseball playing days? You never suffered an injury?

ZACH: No, you’re right. Ice is first to reduce the swelling. You mentioned baseball, right? I’ve been hit on the arm, I got hit in the face once, you know, with a baseball. Not fun, by the way, I don’t recommend it. And no, ice is more like the immediate injury, heat is like, “Ah, it tweaks, it feels weird, we need to put some heat on it.” So, that’s kind of the way I’ve operated.

TODD: Okay. That’s a good layman’s approach I think.

ZACH: That’s who I am on this podcast, Todd. You know that.

TODD: Yeah.

[Laughter]

Well, you know, I had shoulder surgery recently, and the emphasis, I guess initially, was on the ice but since then it’s been a lot of heat because that blood flow brings nutrients to the site of the injury, so that’s better for you. Would you ever want to do one of those ice plunges?

ZACH: No, those do not appeal to me.

TODD: No, me either.

ZACH: I was gonna ask have you done it.

TODD: No. I can’t think of something I’d least wanna do than jump in 30-degree water.

ZACH: I think about those polar bear plunges they do when you say that, right? Is that what we’re talking about here? Okay, yeah. Never, never, never. Not gonna do that. And that’s supposed to, what?

TODD: Well, that’s what -- they’re doing with healthy people. I think those people think that it just is very reinvigorating or just think of it as a stunt.

ZACH: Now, I would definitely do the opposite of that. Like, jump into a hot tub? Absolutely.

TODD: Yeah.

ZACH: Right? That’s the equivalent, right?

TODD: What if it’s a -- the hot tub is at, like, 104, you’d just jump right in there?

ZACH: Well, as long as I can get out as soon as possible.

[Laughter]

TODD: Well, once you get in there, you warm up to that right away.

ZACH: Yeah.

TODD: But usually if I go into a jacuzzi and it’s like over a hundred, I kinda slowly go in.

ZACH: Okay.

TODD: I can’t imagine, kinda, jumping into it.

[Laughter]

ZACH: Well, we’re talking about ice versus heat today on the podcast. And who did we talk to about this, Todd?

TODD: Well, we talked to Dr. Megan Arthur who is a Primary Care Sports Medicine physician at Houston Methodist.

[Sound effect plays to signal beginning of interview]

Well, welcome Dr. Arthur.

DR. MEGAN ARTHUR: Thanks for having me.

TODD: Looking forward to this discussion on cold versus heat as medical treatments. Two very popular methods. So, just right off the bat, I realize the answer is nuanced and this conversation will be to break down those nuances. But if you could only have one or the other, which would be better for, say, injuries or after working out. Heat or ice?

DR. ARTHUR: Yeah, that’s a good question. So, if we’re thinking about an acute injury or immediately after a workout, ice would be the best option, especially for the acute phase.

TODD: Okay. Talk a little bit about the two forms. What they do exactly, how they work.

DR. ARTHUR: Yeah, absolutely. So, ice therapy, it actually works by decreasing the temperature, the tissues itself. And so, in response to that, we’re causing vasoconstriction. So basically, that means narrowing of our blood vessels, and then that can reduce some blood flow to the area, ultimately reducing some inflammation, minimizing swelling, and decreasing pain. Whereas alternatively, in terms of heat, heat actually works by causing vasodilation of the blood vessel, so it actually promotes blood flow to an area. And so, after the initial acute phase of an injury or after your recovery phase, well, that can actually help to soothe pain as well, and then also promote better blood flow and circulation.

TODD: And that blood flow brings nutrients to…

DR. ARTHUR: Correct, to promote healing.

TODD: If that inflammation is the way the body naturally repairs injury, why interfere with that?

DR. ARTHUR: Mm-hmm, that’s a very good question. So, there’s a balance. So, we know that inflammation is a natural part of our body’s ability to recover. But there can be some excessive inflammation, and as a result, it can be quite painful. And so, ice therapy can actually be helpful to decreasing pain, minimizing some of that excessive inflammation so that we can help to decrease secondary tissue damage. But the key is that ice should only be used in the acute phase because if prolonged exposure, prolonged use could actually cause that delayed recovery.

TODD: So, the acute phase is, what, 24 hours?

DR. ARTHUR: Yep. Twenty-four to forty-eight hours.

TODD: Seems like there’s a conventional wisdom that heat’s good before a workout, ice is good after. Is that a good general rule?

DR. ARTHUR: Yeah, I think that’s a really good general rule. I usually say, you know, heat before about 15-20 minutes before your exercise, and that can help to decrease stiffness, promote flexibility, whereas after you work out, then ice for about 15 minutes can help to decrease that muscles soreness.

TODD: Ice is better for inflation, heat is better for soreness?

DR. ARTHUR: Yeah, in general -- as a general rule, yeah.

TODD: Are there people who just respond to one more than the others? Like, I never seem like I get that much benefit from ice and I love heat. Is that sort of almost a, kind of, genetic thing with some people or should everybody respond to ice or everyone respond in the right circumstances to heat?

DR. ARTHUR: Yeah. I think you bring up a good point in that individual response is also key in this. And so, some people just in general, may respond better to heat versus ice. And so, I think using your body as a guide and seeing what, you know, provides better pain relief or soothing pain relief, either one is helpful. Neither of them are necessarily going to hurt you. But if your response is better tolerated to heat, then that’s totally a good option.

TODD: I had shoulder surgery recently, and once the local anesthesia wore off, there was a lot of pain. And the initial pain killer they gave me wasn’t getting it great. So, I was using ice and that wasn’t really doing much. And so, I got them to prescribe another pain killer, and that worked great. So, I didn’t end up taking a lot of ice…

DR. ARTHUR: Yeah, yeah.

TODD: So, I just wonder if that’s, kinda, me. I never seem like ice gives me that great of a relief.

DR. ARTHUR: Yeah, yeah.

TODD: You know, I think of cold and heat therapy for injuries, workouts. But are there medical conditions that benefit from the two? Either of the two?

DR. ARTHUR: Yeah. So, when we think about other things, so for example, like, gout flare where you have this intense inflammatory response in the joint. So, ice can actually be really helpful for that, especially minimizing that pain from that acute inflammation. Also, thinking about more chronic things, so like headaches or migraines, ice can actually be helpful for that. But then other things, so like osteoarthritis or chronic pain from that, or chronic, sort of, muscle stiffness and pain from low back pain, heat can actually be soothing and helpful in that regard.

TODD: So, are the terms “cryotherapy” and “thermotherapy,” are they kinda just fancy words for what we’re talking about or are they more of sort a different animal.

DR. ARTHUR: So, in general, cryotherapy means cold therapy and thermotherapy means heat therapy, but there can be different types. So, for cryotherapy or cold therapy, anywhere from ice packs to cold or ice baths, maybe even the cryochambers. Whereas heat therapy, we’re thinking heating pads, warm baths, or even like saunas for example.

TODD: So, I have had a sinus treatment cryotherapy for it, in which they threaded a catheter up my nose and injected the freezing solution into the nerve, which actually worked quite well. But are there a lot of things like that?

DR. ARTHUR: Yeah. So yeah, so different -- so, for example, for treatment of warts for example, on the skin, we use cryotherapy for that where you’re basically freezing it off, you know, that lesion on the skin. So yeah, so I think it’s a good general term, but it certainly -- there’s lots of things under that umbrella.

TODD: So, what do you think of some of the more extreme forms of whole-body treatments like ice baths, cold plunges, infrared saunas?

DR. ARTHUR: I think the research in terms of those, it varies. It can be helpful. So, the extreme, like, ice baths and things like that can be helpful for recovery. Many athletes use that for muscle recovery after a workout or practice, which can help to decrease the soreness. Heat, different options such as the saunas, there are some studies that it could be helpful for improving relaxation, maybe detoxing, some benefit for improving circulation and decreasing pain. But I think, you know, the studies, they can vary. And again, it’s more so individual response. As and aside, I will say that cold water immersion, that is a gold standard for heat illnesses. So, a little different topic, but there is really good evidence on that.

TODD: Can you define heat illnesses?

DR. ARTHUR: Yeah. So, heat illnesses, so for example, you have an athlete that’s running a marathon. And so, depending on how overheated they may become, so like heat exhaustion, so there are certain symptoms that they may develop, you know, after or during the race. And so, we are able to identify that, and then we basically will put them into a cold water bath or ice bath to really help decrease that body temperature to help treat that.

TODD: But how about those cold plunges that people who are healthy do just ‘cause they think there are benefits to that. Is there any research on there -- out there? Does it improve circulation or anything like that?

DR. ARTHUR: Yeah. I mean, there are some studies out there. In think in general, the key is more so for recovery of your muscles which can help decrease that muscle soreness.

TODD: And how about the idea of contrast therapy where you’re alternating heat and cold. When’s that appropriate and beneficial?

DR. ARTHUR: Yeah, I think that can be helpful. So, I usually will say starting with ice. So, if you’re -- if it’s an acute injury for example, you know, starting with ice for 15 minutes at a time, and then you can alternate that with heat. And so, the idea is that we’re actually promoting better circulation and improving, you know, recovery, and the end actually promoting the healing process through that.

[Music to signal a brief interjection in the interview]

TODD: After the break, more with Dr. Arthur about heat versus ice.

[Music]

[Sound effect signals brief interjection in the interview]

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[Sound effect signals return to the interview]

 

TODD: I think more of us have heard R.I.C.E therapy, which is rest, ice, compression, elevation.

DR. ARTHUR: Mm-hmm.

TODD: I’ve seen some stuff that that’s, kind of, losing some popularity. I saw the originator no longer advocate it and there’s some momentum behind alternative approaches. The acronyms I hear are L.O.V.E and P.E.A.C.E. Can you talk about all that phenomenon?

DR. ARTHUR: Yeah. So, the idea is we’re actually thinking of a more holistic approach to this as opposed to just resting, ice, compression, elevation. Whereas the P.E.A.C.E acronym, that stands for protection, elevation, actually avoiding anti-inflammatories, compression, and then educating. The L.O.V.E acronym focuses more on load, optimism about your injury or recovery, vascularization, and then also exercise. So, the combination of the two, it’s more of a focus on protection, early mobilization and exercise, load management, and we found that that actually promotes healing and recovery better as opposed to just resting. And then when we’re combining ice with anti-inflammatories, well it can actually really damper that inflammatory response that we need. And so, as I mentioned before, ice during the acute phase is totally fine, but we found that we probably don’t want to do lots of anti-inflammatories with that. So, Tylenol would actually be better as it’s not an anti-inflammatory. But the key is more so focusing on protection, early mobilization, early exercise to really promote healing.

TODD: And so, is that gaining a lot of traction as opposed to the age-old idea of R.I.C.E?

DR. ARTHUR: It is. Yes, it is.

TODD: You like that philosophy?

DR. ARTHUR: Yeah, but I think it incorporates a lot of other things, and it allows us to, you know, be able to educate about, you know, your injury. For example, an ankle sprain. Before we found that -- initially, we thought that maybe rest, ice, compression, elevation, you know, would lead to a good recovery. Well, we found that actually protecting, so using, like, a lace up ankle brace or a boot earlier on, allowing the patient to be able to walk earlier on as tolerated. Limiting anti-inflammatories, but also working on exercising, improving ability actually does help promote faster recovery.

TODD: So, do you ever run into patients who use the inappropriate form of ice or heat? They use the wrong one when they should be using the other one. What are the consequences of that?

DR. ARTHUR: That’s a very good question. I don’t necessarily think that there is an inappropriate way to use it. Again, individual response is key. For example, if you have an acute injury, so an ankle sprain or muscle strain, and you’ve tried the ice, you know, for the first couple hours, and it hasn’t been helpful, and you want to experiment with heat, that’s totally fine. I will say just keep in mind that sometimes, for example after an ankle sprain, you may have a lot of swelling. And so, adding some additional heat to that could actually potentially make the swelling worse, you know, initially. And so, the idea of the ice initially can help to minimize that. But, as a general rule, using your body as a guide and finding out what works best for you is fine as well.

TODD: Okay, so tips for people doing their own cold or heat treatments for injuries in working out. Can you ice too much for instance?

DR. ARTHUR: Yeah, so my general rule is no more than 15-20 minutes at a time because we don’t want to cause any additional skin irritation. And things you can use can be anywhere from an ice pack, it can be like a cold towel, you can use, like, a frozen bag of vegetables, like frozen peas. Those things could be helpful to use at home.

TODD: And 15-20 minutes how many times a day?

DR. ARTHUR: I usually say -- so if we’re thinking an acute injury, every two to three hours, but if you’re just using it as a general, you know, way for pain relief, then I usually say two to three times a day.

TODD: And how about heating, can you do too much of that?

DR. ARTHUR: You can, yeah. So, similar to ice, you don’t wanna have your skin exposed to heat therapy too long. But the same thing, warm cloths, heating pads, warm compresses, warm baths can be helpful too.

TODD: Is there a best form of heat? Spas, heating pads, muscle rubs, any of them, or they all, kinda, serve their purpose?

DR. ARTHUR: Yeah. I think they all could be helpful. Again, it’s more so your personal preference. I will say the muscle rubs, they have minimal, sort of, heating type effect, it’s more of like a numbing sort of pain reliever, yeah.

TODD: How about alternatives to ice packs or conventional icing things like KT tape?

DR. ARTHUR: KT tape itself, it wouldn’t necessarily be for, like, that cooling effect, but it can provide support, for example, for supporting the knee or taping the ankle. It can provide support, which essentially could help reduce pain.

TODD: Alright, is there anything I didn’t ask that you would like to add? Things you hear from your patients that would be good for our listeners to know?

DR. ARTHUR: Yeah. I think I do get a lot of questions about when to use ice versus heat. And I always say that, you know, when we’re think -- it’s really important to think about the nature of the injury, the timing of the injury, and then their own individual response. And so, together we can sort of come up with a plan that works best for them, but as a general rule, for more acute type injuries, I usually recommend, you know, ice, you know, for the first 24-48 hours, every two to three hours as needed, 15-20 minutes at a time. And then, after that acute phase, then heat can actually be really helpful as well too. But also using your body as a guide.

TODD: Alright, very good. I appreciate your time on this. That’s been very educational.

DR. ARTHUR: Thanks so much for having me.

[Sound effect plays to signal end of the interview]

 

ZACH: So, R.I.C.E versus P.E.A.C.E and L.O.V.E, Todd.

TODD: Yes, these are changing times we live in.

ZACH: Yeah.

TODD: I had actually heard of P.E.A.C.E and L.O.V.E about six months before, but I was not sure if it was, kind of, this fringe, holistic thing, and that R.I.C.E, which was what we all have known over the years --

ZACH: It’s what they told us to do.

TODD: Yeah.

ZACH: Yeah.

[Laughter]

TODD: I like this idea of P.E.A.C.E and L.O.V.E, which if I might simplify this, I think it’s sort of less reliance on reducing inflammation because that’s beneficial to the healing process, and more on keeping you active while you’re rehabilitating.

ZACH: That is a lot of letters to remember though.

[Laughing]

TODD: I think I could do it if you --

ZACH: Oh, you think you can list it so well? Okay, well try it. List off the P.E.A.C.E and L.O.V.E for us, Todd.

TODD: P.E.A.C.E is protection, elevation, avoiding anti-inflammatories, compression, education.

ZACH: Okay.

TODD: L.O.V.E is load, optimism, vascularization, and exercise.

ZACH: Great. Nailed it.

TODD: Yeah.

ZACH: P.E.A.C.E and L.O.V.E expert over here, Todd.

TODD: Well, you know, I’m from the 60s.

ZACH: Yeah.

[Laughter]

No, I’m fortunate enough where I haven’t had a lot of injuries where I’ve had to, kinda, have to make these decisions and go through these processes, but it’s good knowledge to have ‘cause these kind of injuries can happen when you least expect it.

TODD: Yes, yes. I can say that firsthand. Everything can be great and then suddenly you get injured and it can, kinda, change your life. You have to decide what the best approach is. One thing she said that interested me was that she talked about what’s good for the individual. You know, that some people respond better to ice, some people respond better to heat. I personally respond better to heat. Don’t be too slavishly devoted to doing one or the other based on what you think the experts say. If your body is telling you one is better, do that one.

ZACH: Yeah, yeah. ‘Cause if you’ve not seen results with one, try the other. Just common sense, right? And if you’re wondering, “Is it bad for me to use heat when I’m supposed to use cold?” Fortunately, according to Dr. Arthur, no.

TODD: Right. With the caveat that you probably don’t want to do heat right after an injury ‘cause you could be adding to the problem, she was generally -- what works for you works best.

ZACH: Yeah, I don’t know who would -- Like, if I got hit in the face with a baseball, I’m like, “Let me go put a heating pad on it. Like, I don’t -- that’s not my inclination, right? But you never know, alright? I mean, if you have a heating pad and you’re hurting and that’s the closest thing to you, you might, you know -- you ever use those microwave heating pads with the rice that you heat up in the microwave?

TODD: Yeah.

ZACH: You like those?

TODD: Yes, I do.

ZACH: Okay, cool.

TODD: I haven’t used them much, but the time I used them, I thought it was kinda cool.

ZACH: No, I like how flexible they are and that sort of thing in the quick heat and that sort of thing.

TODD: Yeah.

ZACH: One advantage though about using heat over ice is ice melts and it gets wet...

TODD: Yes.

ZACH: Right?

TODD: Yes.

ZACH: It’s always an annoyance.

TODD: Yes.

[Laughing]

I put them in Ziploc bags now, and I feel that works better, but I still -- it can get messy.

TODD: Yeah.

ZACH: So, the -- score one for heat there, I guess. But look, basically take care of yourself. If you get injured or if you’re having a soreness, like, take action, you know? Put some ice or heat on it, and do a little bit of research if you’re not sure, and pick the appropriate tool.

TODD: Yeah, I think one key thing she said was whichever you choose, do it, like, 15-20 minutes two or three times a day. You don’t wanna be doing it too much.

ZACH: Right. Like, you don’t wanna sit there all day with ice on your leg. That is an overuse. It’s not gonna cause permanent damage or anything, but there’s no benefit.

TODD: Right.

ZACH: Yeah. Alright, Well, that’s gonna do it for this episode of On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings. So, until next time, stay tuned and stay healthy.