How to Know Which is Best for You
We all know that treating an injury immediately after it happens can help minimize the pain and damage as well as facilitate recovery. But after rolling your ankle in a soccer game, or hurting your back when lifting your toddler, or tweaking your knee when stepping out of your car, what's best? Should you ice it to try to control inflammation, or would heat be better to promote circulation? While it's difficult to establish a fail-safe rule for when to apply ice or heat, the general directive is to use ice for the first forty-eight to seventy-two hours after an acute injury and then switch to heat.
It Depends. The reality is that many conditions are not necessarily the result of a specific injury. I call these conditions "recurrent acute" and find them by far the most common: sciatica that occurs when you drive a car; a back that flares up every time you garden; or tennis elbow from intense computer work. In these cases, consistent and frequent applications of ice may prove very helpful over long periods of time, particularly immediately after experiencing the event that causes problems.
Conversely, back or other muscle spasms caused by overexertion rather than injury may benefit greatly from heat immediately upon the onset of symptoms or immediately after exercise in order to relax the muscles and increase circulation. Also, muscle belly pain not resulting from acute and serious trauma generally responds well to heat, which can break the spasms and release the strain. On the other hand, nerve and tendon pain--regardless of the duration of symptoms, even if you've been experiencing them for months--benefit from ice.
What Works for You. The bottom line: different individuals will constitutionally vary greatly in their reactions. Some people are more prone to the types of inflammation exacerbated by heat, while others find their bodies contracting and tightening at the mere mention of ice. Try each option and pay close attention to how your body and mind respond, and let your gut be your guide. Ultimately, what works best for you is, well, what's best for you.