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Ice vs. Heat: Which to Choose for Your Pain

The best practices for finding relief from minor injuries and chronic aches

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Few things are certain in life, but aches and pains are a given, especially as we age.

Research shows that older adults are more active than ever, donning sneakers for a game of pickleball, hitting the trails to train for a marathon, even digging in the dirt to tend to a garden. (Trust us when we say that all the major muscle groups are working when you’re out there weeding, raking and planting.)

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But all this activity, while great for your health, can leave you with some pain — be it a pulled muscle or inflamed joints. Ice and heat therapy have long been the go-to methods to relieve pain, but confusion persists over which to choose. Here’s what the experts have to say.

When to chill

You just hurt yourself. Ice can help to numb the pain and decrease swelling, explains Andrew M. Walker, the health and wellness manager for the nonprofit National Senior Games Association, which is why it’s a go-to for sudden, or acute, injuries.

“Let’s say you sprained your ankle and there is acute swelling,” says Michael Fredericson, M.D., a sports medicine physician and founder and director of Stanford University’s RunSafe Injury Prevention Program. “Ice can help control pain [and is] very good at decreasing inflammation and swelling.”

Ice isn’t a stand-in for a trip to the doctor’s office. That said, minor sports injuries can usually be treated at home by using the R.I.C.E. method, an acronym for the four elements of a treatment regimen: rest, ice, compression and elevation, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

“You do want to elevate [the injured area], you want to put compression on, you want to have ice on there. You don’t want to start motion right away with an acute injury,” Fredericson says.

You have joint pain. Ice can also be helpful when it comes to relieving pain caused by more chronic conditions such as arthritis, says rheumatologist Grace Ahn, M.D., of Arthritis and Rheumatism Associates in Wheaton, Maryland.

One study found that people with osteoarthritis in the knee — this is the wear-and-tear type of arthritis common among older adults — who massaged with ice for 20 minutes, five days a week for two weeks, saw improved muscle strength in the leg and better range of motion in the knee.


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Don’t have a stash of fancy ice packs? No problem. “I often tell patients to use frozen peas or any vegetable bag if they don’t have ice packs,” Ahn says. You can also dampen a towel, put it in a resealable plastic bag in the freezer and take it out when you need it, Ahn says. As far as timing goes, aim for 10 to 15 minutes at a time for a few times a day.

A few words of caution: People who have conditions that make them sensitive to cold temperatures, such as Raynaud’s, should be careful when using ice, Ahn says. The same goes for those with poor circulation or sensory disorders.

When to turn up the heat

You have an older injury. If your injury is several days or weeks old — or one that has been lingering even longer — it’s OK to turn to heat, like a heating pad or a heat wrap, both of which are available at drugstores.

However, you don’t want to use heat right away on an acute injury because it can increase inflammation around the injury and interfere with healing, according to the Cleveland Clinic. But for older issues, and especially muscle injuries, warmer temperatures can help to facilitate mobility, decrease pain and increase blood flow, Walker says.

If you have a joint that feels stiff, for example, and “you want to try to loosen it up, that’s where gentle heat can be helpful,” Fredericson says.

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Meryl Alappattu, a physical therapist and research assistant professor at the University of Florida in Gainesville, says she often uses heat to help people with chronic pain start moving at the beginning of a therapy session. “It helps them loosen up a little bit before we start an activity,” she says. “At the end of the session, if they’re sore, worn out, [or] experiencing any pain, we may end the session with an ice pack.”

One thing to know: Heat can aggravate symptoms of dermatitis and multiple sclerosis, so be careful if you have these conditions. People with diabetic neuropathy, a condition that reduces your ability to feel pain or temperature changes, should also exercise caution. To avoid burns, make sure you remove the heat if it ever gets uncomfortably warm.

With any of these therapies, “you want to be careful not to use it too long, and not to put it over areas where you might have a nerve exposed, such as on the outside of the knee or around the elbow,” Fredericson says.

A few more tips:

Be proactive. If you’re nursing a new injury or battling more chronic pain, carry an ice pack or self-activating heat patches — whichever is best for your situation — in your bag or car to use while driving or at work.

Stay active. It may seem counterintuitive, but if your pain is caused by osteoarthritis, which affects more than 32.5 million Americans, one of the most effective treatments is movement. Walk, rather than drive, and take the stairs, if possible. “Once you become inactive, your muscles atrophy and then you’re just going to start to develop more pain in your joints,” Fredericson says. “The biggest thing you can do is stay active every day.”

Engage your core. Depending on where your injury is, you might want to try stretching and strengthening exercises to support your core muscles.

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