• Lucy Adie

OsteoBlog: Fire and Ice

There is much written about the use of ice packs and heat pads for the treatment of sprains, strains, muscle pain and various other injuries and conditions. Some are advocated by the National Institute for Health and Care Excellence (NICE) guidelines for health professionals and some are purely anecdotal.

Heat and cold therapy modalities are reasonably benign and non invasive when used appropriately but there are contraindications at certain recovery periods.

Ongoing evidence is conflicting. My Chinese doctor acupuncture tutor always used to say, "Ice is for dead people!" He advocated heat to improve blood flow in all cases.

A.T.Still, the forefather of Osteopathy said, "The rule of the artery is supreme." He meant that we should aim to improve blood flow at all times.

So what are we trying to achieve when we use ice or heat?

Ice is often used to reduce inflammation, swelling and pain when we have sprained an ankle or banged our head, and it does actually work in most cases. The cold will constrict blood vessels, reduce blood flow, cool the area and numb it, providing pain relief.

Heat is often used to soothe and comfort muscle aches and pains. It dilates the blood vessels and improves blood flow, promotes muscle relaxation and provides a comforting warm feeling.


When we injure ourselves or have an infection, the body mounts an immune response to heal itself and the process is called inflammation.

Inflammation is characterised by redness, heat, swelling, pain and immobility/stiffness. Local blood vessels dilate to increase flow and white cells diffuse through the walls of the vessels to engulf bacteria and prevent infection, and they are often accompanied by fluid which causes the swelling. This protects the area and stops excess movement while the injury is healing. Clots will form to stop any capillary bleeding and the same substances cause pain and heat.

The process, therefore, is required in order to promote healing in the damaged tissues so trying to control it too much actually increases recovery time.

The body does, however, sometimes go over the top with its response and can trigger new inflammation on top of old. This is when chronic inflammation develops which can cause further problems, inhibiting recovery.

So, we can see how ice will help to control inflammation if used from 48 to 72 hours post injury, allowing for some of the process of healing but preventing shutting it down completely. Used immediately after the event, the evidence so far concludes that ice serves no contribution to recovery. NICE advocates using ice during the above timeframe and recognises its short term pain relief function. We can also see how heat may well make things worse at that time, increasing the bleeding and prolonging recovery.

Ice or heat are safe treatments with very few side effects when used correctly, can contribute to a feeling of wellbeing and have some effect on pain.

The general protocol for ice therapy is to wrap the ice pack or bag of frozen peas in a towel and apply to the damaged area for no longer than 10-20 minutes. Make sure the skin does not change colour to red and allow the temperature to return to normal before applying again. In most cases, this means using ice once every hour. Wrapping it in a towel avoids causing ice burns to the skin and if the skin reddens then this is the body trying to heat the area by sending in more blood, which is the opposite of what you are trying to achieve.

Heat pads are a little easier to manage as they can be used ad hoc for as long as you need. Obviously take care not to over heat if using a microwaveable type, but there is no real time limits as the pad will just cool down!

Below is a list of some of the conditions which NICE recommend ice or heat for. As a health professional, it is good practice to be advised by these guidelines:


Bursitis - pre patellar, olecranon or trochanteric




Plantar fasciitis

Sprains and strains between 48-72 hours post onset

Low back pain

Torticollis (neck spasm)

Ankylosing spondylitis (spine condition)


Dysmennorhea (period pain) and other cramps

Restless leg syndrome

Jaw pain


Low back pain


Ankylosing spondylitis

Aching muscles after exertion

Fibromyalgia and chronic pain conditions

Some conditions, as you can see, respond well to both heat and ice.


You may well have heard of people using ice and heat baths alternately to treat an injury.

The idea behind this contrast therapy is that the forced dilation and constriction of the blood vessels to the injured area creates a pumping motion. This brings healing blood to the area and carries away waste products and drains swelling, thus promoting a more speedy recovery.

According to an article by Carol Fawkes from the National Council for Osteopathic Research (NCOR), contrast bathing has demonstrated physiological and beneficial therapeutic effects but no dose or protocol has been developed as yet.

Contraindications, however, include open wounds, poorly controlled epilepsy and high blood pressure.

In short, it is very much down to patient preference as to whether heat or cold can be used to manage an injury. Either way, recovery times are not affected too much, but the psychological effects of applying a treatment may well prove beneficial as well.

If you are unsure of which treatment to use then please seek advise from your GP, practice nurse or osteopath.

Further info:


As always, for Osteopathy in High Wycombe and beyond, please call Lucy from OsteoFusion on 07833 321604 or visit

Thanks for reading.

#ice #heat #cryotherapy #thermaltreatments #icepack #heatpads #inflammation



  • Facebook Social Icon
  • Twitter Social Icon
  • Instagram Social Icon