Should You Use Heat or Cold?

The other day I pulled a muscle in the front of my thigh during a boot camp class.  I felt a painful “ping” in my leg while I was doing some lunges.  When I went home, I knew the muscle needed some attention, but what?  Should I put ice on it or heat?  One of the most frequent questions we get from our acupuncture patients is whether to apply heat or cold to an injured or painful area. This seems like a simple enough question; except it isn’t all that simple. There are a few things to consider when deciding between a heating pad or a bag of frozen peas.

First, the properties of heat in Chinese medicine are that it creates movement. This means that fluids, blood, and energy in an injured area flow better with heat. This movement serves to dilate the blood vessels, loosen tight muscles, increase range of motion, and promote healing.

When to use heat or cold on an injuryThis sounds pretty good. So why wouldn’t you put heat on just about everything? Well, because good health is all about flow, practitioners of Chinese medicine tend to recommend heat in most circumstances. However, there are a few instances in which cold might be a better choice.

The Chinese think of cold as a river freezing up in the winter–it contracts and slows down. This is also what happens in your body when you apply ice to an injured area. It constricts the vessels and minimizes swelling. During the first hours and days after a traumatic injury, it’s actually a good idea to use ice to keep the swelling down.

Choosing between hot and cold becomes a little trickier in cases of inflammation. In general, inflammation is hot, so you should put cold on it, right? Well, not always. Remember that heat increases blood flow to the area, and increased flow promotes healing.

So how do you determine which to use? Here are a couple of guidelines:

-In general, use what feels better and pay attention to the weather, especially with chronic pain. If your pain is worse in the cold, damp weather, apply heat. If it’s worse in the warm weather, use cold.

-Feel the area of pain. Actually touch it. Frequently it will feel cold from lack of circulation or warm from inflammation. If it feels cold, warm it up. If it’s swollen and hot, use some ice.

-Don’t be fooled by the numbing properties of cold. Your injury may feel better for an hour or so after you’ve iced, but if applying cold makes it worse in the long run, go for heat.

-For sports injuries, physical therapy exercises, or just using your injured area; warm it up for ten minutes or so before use. This will loosen the muscles and increase your range of motion. Then cool it down for five or ten minutes after your workout.

-Do not apply ice to a muscle spasm; it will make it worse. Remember, cold contracts, so icing a painfully contracted muscle will make it hurt more. I learned this the hard way. By the time I figured out that the cold was aggravating a spasm in my lower back, I could hardly walk. How do you know if it’s a muscle spasm? Generally, the pain is pretty sharp, comes on quickly, and inhibits your movement. A high percentage of back pain is caused by muscle spasms.

-If you have a traumatic injury, apply ice for the first 24 to 36 hours to keep the swelling to a minimum. After that time, apply ice if there’s still swelling, if not go with heat, or alternate between heat and cold.

As for my pulled quad muscle, I decided to start with cold.  The muscle wasn’t in spasm, just sore that first day.  After one day of icing in the morning and evening, I switched to heat for a couple of days, and after two days, the muscle felt pretty good and ready for more boot camp punishment.

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