I get this question too many times a day to even count. So, I thought I would spend some time laying out why I might recommend heat for one person and ice for another.

Both heat and ice are helpful tools in pain management. Although there are many theories as to why they work, the research is incomplete and there is still much that is unknown. One main theory for icing, for example, is that the reduction in temperature reduces the conductive ability of your nerve to relay information back and forth, therefore not allowing the ‘alarm signal’ of pain to be expressed as quickly. It is also understood to be helpful for inflammation as blood flow to the area is decreased. Heat, on the other hand, promotes blood flow to the area, which is helpful for healing. Heat activates certain neurotransmitters which blocks the ability for our body to perceive pain.

WHEN TO USE ICE
You have an acute injury (e.g. ankle sprain), within the first 48 hours
Inflammatory conditions (e.g. rheumatoid arthritis, ankylosing spondylitis)
Red, hot, swollen tissue

WHEN TO USE HEAT
Acute low back or neck pain
Chronic pain
Muscle stiffness

HOW TO USE ICE
Make sure the ice is covered or wrapped in a wet cloth, and not against your bare skin to protect from frostbite (I’ve done this before. It’s not fun – I promise!)
Use the 20:20:20 rule – 20 minutes on, 20 minutes off, 20 minutes on. This can be repeated several times a day

HOW TO USE HEAT
If you have sensory issues, be careful not to burn your skin
Heat can be applied much longer than ice and there’s really no guideline – just make sure you are awake and aware of the sensations you are feeling so as not to become injured

Having said all that, each person and each body is different; what works for one person might not work for someone else. So, if you love ice and find it’s super helpful for your chronic pain – GO FOR IT!

As with everything, there are precautions and contraindications to all forms of therapy. Make sure you speak with a regulated health care professional to make sure that ice and/or heat is safe for you before using it.

Author: Dr. Allie Dennis

RESOURCES:
Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British Journal of Sports Medicine. 2007;41(6):365-369. doi:10.1136/bjsm.2006.031237.
Nadler SF, Weingand K, Kruse RJ. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician. 2004;7:395-9.
Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2015; Early Online: 1-9.

Why does my body hurt after a workout?
You know that feeling a day or two after a really tough or new workout? The one where everything just hurts? Well that pain has a name! You might be suffering from something called DOMS (aka Delayed Onset Muscle Soreness).

What is DOMS?
DOMS is muscle pain that typically begins approximately 12-24 hours after a particularly difficult or new workout. The pain tends to peak between 24-72 hours after the offending exercise routine and can sometimes last up to 1 week!

Why does DOMS happen?
For many years it was believed that a build-up of lactic acid was the cause of this post-workout pain; however, more recently this has been proven untrue. Although there is still some controversy and unknown variables surrounding the exact mechanism of DOMS, the current general consensus is that it is related to the healing of microtears or microscopic damage to your muscle tissues that occur during eccentric contractions. Eccentric contractions are what happen when your muscle is both contracting and lengthening at the same time (for example, when bringing your arm back down in a slow controlled manner during a bicep curl, you are eccentrically contracting your bicep – keeping that contraction while bringing the muscle into a position of length).

How do I make it feel better?
Again, for this, the evidence is conflicting. Mostly, just giving your body some time to heal will help you out. This isn’t to say you should go sit on the couch and wait it out! Out of all of the poor evidence on treatment for DOMS, exercise has been found as one of the most effective methods (MOTION IS LOTION!). Instead of another gruelling workout right off the bat, try some lighter movements like a light jog, some light yoga and stretching for a few days before getting back into it. Things like ice or an Epsom salt bath might help speed things along as well but the evidence is poor on these. Make sure you are always hydrating!

Can I prevent DOMS?
While DOMS may not be entirely prevented unless you just don’t move ever (in that case, you’ll likely end up with worse problems than just some good ol’ DOMS), there are some ways to reduce the severity. When you’re starting a new exercise, make sure you progress slowly into it to give your muscles time to react to their new demands. Some evidence shows a proper warm-up and cool down might also be beneficial in prevention.

What if it isn’t DOMS?
If the pain occurs DURING the workout, if the pain persists beyond 1 week, or it is preventing you from doing your activities of daily living, then it might be something else. Make sure to seek care if things aren’t progressing the way you think they should. Of course, you always need to trust your own body and seek care if something doesn’t feel right.

Author: Dr. Allie Dennis

Resources:
Cheung K, Hume PA, Maxwell L. Delayed Onset Muscle Soreness: Treatment Strategies and Performance Factors. Sports Med. 2003; 33 (2): 145-164.
American College of Sports Medicine: https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf