“Is it better for me to use heat or ice for this muscle?” I hear this question frequently from massage therapy clients, and I wish it was easy to answer.
For years the loose guidance has been “ice for immediate injury, heat for achiness and improved mobility.” You’ve probably heard of the RICE acronym (Rest, Ice, Compression, and Elevation).
So… ice, ice, baby?
In 1978 Dr. Gabe Mirkin created the acronym and included ‘RICE’ in his sports medicine book as a treatment for soft tissue injuries. The idea was to reduce inflammation that can increase pain and slow down healing. It was logical — and it seemed to work — so the sports world adopted this practice, and medicine soon followed suit. I remember being taught about RICE in massage school, also.
Since then, Dr. Mirkin has reversed his support for the RICE method, based on a large number of studies that have shown mediocre results (or no particular benefits of RICE at all). And we now know that swelling & inflammation are not the same, and they don’t necessarily correlate to healing time.
Hmm… if the RICE protocol is out the window, should I use heat or ice?
First and foremost, do what is comfortable for you. If you hate being chilly, ice is a terrible idea. If you are always warm & uncomfortable, a giant heating pad is probably not appealing to you.
Next, consider what ice or heat does overall. For many people ice (or just cold) can kick up the nervous system and make the body feel like it’s in danger. Whereas heat, especially in the form of a weighted heating pad, can be really calming and relaxing to the whole body.
With all that in mind, here is my general view on Heat versus Ice:
If you have seen a physician, physical therapist, or any kind of medical provider for your symptoms, follow their advice. If their recommendation feels uncomfortable or if you feel like it makes your symptoms worse, reach out to them for more guidance.
If you’re opting for a DIY route to care for a minor injury, I suggest applying ice as soon as you get the chance. If you were doing something strenuous and can feel a tender spot, and the area looks a little puffy, go for the cold. Use ice for 20 minutes once an hour or so, and see if your symptoms improve or change.
And be sure to use a towel or some other protective barrier between your skin and the ice or cold pack. That’s because you can accidentally develop frostbite if a cold pack is left directly on your skin for a long time! I observed that with someone who was using ice at home several years ago. Less is more.
(A personal hydrotherapy anecdote: my friends used to live in a huge home in P-town. One night, I gracefully slipped on some backyard pavers, slid into their lily pond, and broke a toe. They were having a birthday party and had run out of ice, so I sat on the edge of the swimming pool and soaked my foot in the water. The moral of the story: If you don’t have an ice pack, a package of frozen peas or corn can substitute. If there are no veggies to be found in the freezer, any old port in a storm – like my swimming pool improvisation.)
I’ve also found applying a cold washcloth on the head or face to be beneficial if you have a headache. If you’re experiencing sinus pain, that may also help. If you frequently get these headaches, remind me the next time you come into the office for an appointment, and I can show you some sinus acupressure points that you can self-massage.
The heat is on
For tense muscles, general or deep achiness, or feeling straight-up “tight,” I like to use heat. Possibly heat with some weight behind it. I’ve found it to be calming to the whole body and demonstrably helpful in encouraging everything to ‘unclench’.
In this article from the Cleveland Clinic, they advise against using heat for acute injuries, gout, or tendinitis. If you have areas with reduced sensation (such as neuropathy in your feet or hands), it’s recommended to use caution to avoid further tissue damage.
Tension headaches are often relieved with heat to the shoulders and neck. But for migraine sufferers, use whatever option – hot or cold — feels best for you.
When you come into my office for your massages, we have a couple of options for using heat. My table has a cozy fleece warming pad on it, which we can employ during your entire session, or just a portion of the time. And I have a special towel-warmer, too. Many clients love having a warm towel applied to their back or feet.
Let’s make a plan
Just as your “best massage” is the massage that’s most helpful for you, customized for your goals and your health situation – “Should I use heat or ice?” — ultimately the choice is, what feels best to you!
So, let me know if you have questions about massage therapy and how it can support your health and well-being. Together, we can plan your session so that massage is an enjoyable solution for you. Check my schedule online here and you can book your next massage!