iStock 531626964 Woman putting an ice pack on her elbow pain - When You Should Apply Cold Or Heat To Aches and Pains

WHETHER TO USE ICE OR HEAT TO ALLEVIATE PAIN DEPENDS ON WHAT IS HURTING AND WHEN IT WAS HURT.

You are pretty sure you sprained something in your lower back. The pain is uncomfortable and you can barely walk, so a soak in a warm, swirling hot tub seems like just the ticket to recovery, yes? Or would an ice compress make more sense?

The answer is ice. Or, it might be heat. It all depends on what’s hurting your back and when it was hurt. If you’re confused, don’t be embarrassed: People get this mixed up all the time. Learn the basics and your recovery from life’s aches and pains will come quicker and be more complete.

To start, it helps to know how cold and warm temperatures affect muscles, tendons, ligaments and joints.

  • Ice causes blood vessels to narrow (a vasoconstrictor), which limits internal bleeding at the site. That is why ice is recommended for recent injuries (rapid-onset trauma involving strains or sprains, minor contusions, or injuries with minor breaks in the skin). Ice also numbs the tissue and slows neurological impulses, reducing the pain.
  • Heat widens blood vessels (a vasodilator), which improves the elasticity of joint connective tissues and increases blood circulation. For the athlete with chronic injury, it can be applied prior to exercise to improve movement and reduce the chance for additional injury.

In short, it helps to reduce blood flow to new injuries with the use of ice. But if the cause of your soreness happened a while ago — usually more than 48 hours prior — the objective is call up more blood and get the blood vessels and muscles to relax more with heat.

How to apply ice

Whether you exercise regularly or simply have chores to do around the house, you might occasionally sprain an ankle or twist a muscle from time to time. I tend to think of minor injuries in the same vein as world-class downhill skiers who fall: an occasional, minor injury says you are striving to do more. That’s a good thing.

For this reason, it is smart to have a plan for treating those injuries. The American Council on Exercise tells its certified fitness trainers to always have chemical ice packs on hand in their first aid kits. The procedure to follow in the case of minor musculoskeletal injuries is what they call RICE: rest, ice, compression, and elevation. It works as follows:

  • Rest: Stop doing what you were doing that caused the injury (and lose the “no pain, no gain” mindset — there are times when pain is sending you an important message).
  • Ice: Apply for 20-30 minutes. But don’t cause frostbite to the injured area; a piece of cloth or other insulation to separate the skin from the ice is recommended. Note also that if the injured area is numb before you apply the ice, you might have a more serious injury and should seek professional medical treatment as soon as possible. A bag of frozen peas or corn works almost as well as ice cubes or a chemical ice pack.
  • Compression: The goal is to reduce a flush of blood to the area. Ice does that through vasoconstriction, but you can also apply compression by way of elastic bandages. Wrap the bandage from a large muscle adjoining the injured area to another large muscle on the opposite side of the injury.
  • Elevation: By raising the injured area above the heart, you reduce the force of gravity on the blood to the injury. This further reduces swelling.

Now grant it, applying ice and compression to a twisted ankle and then elevating it is not something you can neatly accomplish in a business suit in an office setting. But it’s only for a few days. Milk it for sympathy.

How to apply heat

As mentioned, heat is applied when inflammation and swelling from an injury have ceased. This includes chronic back pain as well as any sore, stiff, or nagging muscle or joint pain. Heat is better before exercise or movement because it relaxes the blood vessels and muscles, less so after exercise if the activity re-injures the area (go back to ice if that’s the case).

Moist heat is better than dry heat. A hot, wet towel, athletic hot packs, or heating pads all work. Restrict the application of heat to about 20 minutes.

To return to the original question about an aching back, the answer should be clear: If you recently injured it for the first time, or if activity in the past 24 hours is what aggravated an old injury, apply ice and compression. If it is chronic back pain, apply moist heat.

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