Let's begin by doing a brief recap of our last post pertaining to the use of R.I.C.E., and more specifically, ice. Icing is used to help reduce inflammation, redness, and associated pain. Ice is best used in the first few days post-injury. In general, ice is indicated when you are dealing with any form of "-itis" such as tendonitis or bursitis (and other such inflammatory conditions). Ok, great! Now, what about using heat?
Heat, just like ice, is a wonderful therapeutic agent. Heat is most commonly used to increase blood flow to an area (which is why it's not recommended for swelling and inflammation) and with it nutrient, oxygen, and waste transport; heat has a wonderful action in helping to calm the nervous system; and in these, heat helps facilitate faster healing. Why then do we not use heat immediately post-injury, to help speed healing? Remember that heat exacerbates the inflammatory process, and because of this, it is important to use ice in the first stages of healing after an injury has occurred.
In general, heat is best for treatment of chronic (long term) pain, stress, or muscle tension (except for those "-itises," of course). Heat can be especially effective for muscle spasm and trigger point relief (or conditions that are caused by them, such as back pain or neck pain). Often trigger points are brought on by a combination of factors including ischemia (lack of blood flow) in a certain area, and since a local heat pack will help stimulate blood flow to a specific area, it is a wonderful remedy for relieving active trigger point pain. Heat applied to the low back region (the caudal zone, known for it's concentration of nerve fibers) can actually stimulate a whole-body relaxation response which is especially helpful for stress relief and PMS pain. On the contrary, ice can, and usually will, exacerbate pain caused by muscle spasms or trigger points.
When determining whether to use heat or not, it is always prudent to be considerate of the cause of any symptoms; such as with low back pain, it is important to rule out inflammation before applying heat as heat can make inflammation worse. However, when dealing with tension headaches, stress related bruxism (teeth grinding/jaw clenching) or TMJ disorder, or other stress induced symptoms, heat can often bring soothing relief. For reducing cramping from conditions such as Charlie horses or PMS, heat can even be a life-saver for many sufferers, helping to reduce or alleviate spasms!*
Another important note is that, like commercial ice or gel packs, heating pads are a lot less helpful than they are marketed to be. In fact, studies have shown that dry heat is actually 80% less effective than moist heat! Utilizing a hot moist pack such as a fomentation pack, a homemade moist hot pack**, or even a homemade or commercial rice/flax/corn pack (they do emit a small amount of moisture for a while), can be far more therapeutic than simply slapping an electric pad on the affected area for convenience's sake.
One last consideration for you is that it is always a good idea to ensure that the rest of the body is also cared for in the proper manner prior to application of heat or ice therapy. What do I mean? Let's say that you have a fresh muscle injury, but it is also the middle of winter and the cold-chill of ice therapy sets off greater pain symptoms and causes chills and shivering. If this is the case, it is important to ensure that prior to icing, the rest of the body is thoroughly warmed (by covering up with blankets, or bundling in sweat pants and a sweater, etc.). Conversely, if you are dealing with a severe muscle spasm and it's 102 degrees Fahrenheit, you are already sweating, and you apply heat, the brain may interpret the added heat as an additional threat which could incidentally cause the body to express more pain. If this is the case, it can be a critical factor to cool the body to a more tolerable level before introducing the heat therapy.
The bottom line? The first step is to try to determine the cause of your pain, and then use your best judgment. It is always critical to listen to your body too, but remember that just because something may "feel" better, it may actually be aggravating the cause of your pain. Unfortunately these are not rules that apply to every single situation - there is almost always one or more exceptions to any medical rule - nevertheless, understanding the body's healing processes can help us rule out options that might not be best under any given set of circumstances. We hope that this has provided some guidance for you on the best, and worst applications for both heat and ice therapies. And as always, we'd be happy to visit more if you have further questions.
NOTE: Please use caution with any home remedy. Be aware that the above information is for use as a guideline only and it is always best to consult your healthcare provider to determine the proper course of action, particularly if you are not certain of the cause of your pain.
*Symtoms such as Charlie horse, spasms, and PMS can actually be a sign of nutrient imbalance or hormonal disturbances, give us a call to find out more.
**To make a homemade hot pack, “Hot Pack Sandwich” style, begin by laying a dry towel on the skin, then applying a hot moist towel on top of that, and then cover up the hot moist towel with one ore more additional dry towels to hold in the heat.
Jerri W., LMT, CWC
Licensed Massage Therapist and Certified Wellness Coach with over 23 years of experience in pain management, relaxation techniques and lifestyle education.
Heather R., LMT, CWC
Certified Wellness Coach and Licensed Massage Therapist with a passion for helping others achieve optimal wellness through healthier living.
NOTICE: The information provided herein is meant for educational purposes only. We accept no liability for your use of the information provided. As always, use your best judgment and if in doubt, please consult your healthcare provider to determine the best course of action for your particular situation.