I get asked this question all to often in my practice and that is Ice vs Heat. So what’s the right answer? We are going to talk about a few things about both and then come up with a conclusion. This topic has many different views and has been studied a lot through the years. With the new craze of cryo therapy around, more and more people are turning to this therapy because of the quick source of relief. The truth is that cryo therapy has been going on for years and most athletes have been doing it all along. Ice baths are a form of cryo therapy. Whirl pools/hot tubs are a form of heat therapy. More people have found a way to market and mainstream this process. So lets talk about what happens when you use these therapies.

Ice has been used for many different reasons over the years. Pain management, decreasing inflammation/swelling, temperature regulation and improving muscle performance post workout are just a few of the benefits of ice therapy. But what happens physiologically when you apply ice?

When ice is applied to your body it is a superficial therapy. It can only penetrate so deep into your skin because of the density of your tissue. However it will impact the superficial tissues in a big way. The tissues and blood vessels undergo constriction. This means that the tissue gets tighter and blood vessels and capillaries get smaller. This in turn decreases the amount of blood, lymph, and chemical mediators that travel to an injured site. This is why your swelling slows down when you apply ice. Although we want the body to send the right “tools” to the injured area to help heal it, too much of a good thing is a bad thing. Excess inflammation can cause compartment syndrome choking off blood vessels or nerves, which are vital to your function. This causes pain and discomfort.

Pain often follows injury due to this excess swelling in an area. This is why its important to decrease the amount of swelling. The ice helps numb the area, which causes the pain nerves to not fire as well or at all. That is why your pain starts to diminish. This also helps with muscle recovery because of the decrease in lactic acid buildup in your muscles. Helping to flush out the lactic acid speeds up recovery and improves function, which is why most athletes use ice baths or cryo therapy.

So what about heat? When heat is applied to the body the opposite happens from ice. Blood vessels become larger while the tissues relax and open up. This benefits those people with spasms and tight muscles or when you are trying to improve circulation to an area. Again this heat only goes so deep so it does not impact all the deeper tissues but it does have a big impact on the superficial.

What do you use then? My advice is to first consult a physician if you have been injured seriously. However if you have the option between ice and heat my answer is simple. I tell all my patients to use ice right after an injury. Ice will help with the swelling and pain. This is important to start the road to recovery.

If its an injury that’s been nagging for a long time then typically heat is suggested. However I often recommend a step further. This is partially why the cryo therapy centers are becoming popular. If its muscle tightness or stiffness I will often recommend heat. Depending on the injury, I often recommend an alternation between ice and heat because of the flushing that occurs, which can improve your recovery greatly.

The ice causes a vasoconstriction of the area, which decreases the circulation to the area. Then the ice is removed and heat is applied 10 minutes later. This causes a vasodilation, which floods the area with fresh blood and chemical mediators to help heal it.

So the choice is ultimately yours but my recommendations have been made. If you have any questions feel free to contact me at the office. I would be happy to talk with you.

Dr. Michael Barnard Jr.

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