Patients regularly inquire as to whether certain aches and pains should be treated with ice or cool packs or with a hot water bottle or heat packs.  It’s difficult to give firm advice as either may have pain relieving properties but there are certainly some general rules that we can follow to ensure we get things right.

1.  Ice for Acute Injuries

Initial injury management guidelines for soft tissue injuries specify that icing remains desirable to eliminate a large inflammatory response following an acute injury.  Examples of acute injury include twisted ankle or pulled muscle.  In these instances icing will help constrict local blood vessels reducing the amount of swelling that can accumulate therefore reducing pain.  This will improve recovery times following injury.

2.  Heat for Chronic Injuries

Chronic back pain, frozen shoulders and neck conditions respond better, in my experience to heat therapy.  Heat may be applied using a hot water bottle.  Heat, in contrast to icing, results in increased blood supply to the area being treated, which in chronic conditions can often be pain-relieving.  Heat is a particularly effective modality in the treatment of frozen shoulders and is often used as an adjunct to physiotherapy in improving the condition.

3.  Arthritis and Hot Cold Therapy

Osteoarthritis sufferers often complain that they feel their aches and pains worse in the cold and damp weather.  Often heat therapy can ease and soothe their symptoms and this is to be encouraged insofar as is it gives pain relief.  Conversely, sufferers of rheumatoid arthritis often complain of throbbing heat affecting the small joints of the hand and fingers and express that they get relief from running their hands under the cold tap.  This similarly, should be encouraged as a means of pain relief in sufferers.

When dealing with arthritic conditions it’s important to bear in mind that there are no cures.  So if heat gives you some relief it should be utilised and similarly if icing soothes throbbing hands it’s to be encouraged.

So long as we follow some general rules, such as icing for acute injuries and avoiding heat in initial injury management, we won’t go too far wrong.  After that it’s a case of if it relieves your symptoms it’s probably helping!