Heat or ice or anti-inflammatory meds for injury?

As Physiotherapists, we often get asked the question about whether to choose heat or ice or anti-inflammatory medication.

Should I use heat or ice on my pulled muscle?”

Can heat or ice help muscle soreness?”

“Can I take medication to speed up my recovery?”

But the decision to use heat or ice or anti-inflammatories is not as simple as it seems.

It all depends on the type of injury (muscle v tendon v bone) and what you’re trying to achieve (reduced swelling v pain relief, etc).

What are the benefits of using heat or ice or anti-inflammatories?

Looking at each option and what is has to offer:

Ice packs

Ice packs (such as a freezeable blue gel ice pack or the classic pack of frozen peas), ice buckets and ice massage are often used as mild anti-inflammatories and as pain relievers, particularly within the first few days of an acute (sudden) injury.

But it’s effectiveness as an anti-inflammatory agent has been called into question, with no noticeable effect on improving recovery times after injury.

Ice packs are effective as a pain-reliever and work on most superficial (close to the surface) injuries, although they won’t work on deeper injuries like hip joint pain.

For the negative effects, it carries very little risk other than a skin burn (same for heat or ice, although the type of burn is different).

Heat packs

Heat packs (like a microwaveable wheat bag) are often used to warm stiff joints, on muscle soreness and as a pain reliever.

For joint stiffness and muscle soreness, heat can be quite comforting and relieving.

It should be noted though that it’s only changing your perception of the area, not the function of it.

They work well on structures that are close to the surface, have a good blood supply (the short term increase in blood flow is part of the effect) and a broad surface area (smaller areas come with risk of heat concentration and burns).

For the negative effects, heat packs carry some risk of increasing bleeding after acute injury (like a sprained ankle) however this has not been shown to adversely affect injury recovery times.

There’s also the risk of burns, with the relief from pain often disguising the damage to skin until it’s too late.

Anti-inflammatory medication

Anti-inflammatory meds (Non-Steroidal Anti-Inflammatory Drugs, referred to as NSAIDs, like Nurofen, Voltaren and Advil) are used to control inflammatory process, particularly for gradual onset conditions such as arthritis.

At this point, it’s worth differentiating between two different inflammatory processes in the body – one is a gradual response to sensitive or overloaded tissues. The other is an acute (sudden) response to tissue damage.

NSAIDs work on pathologies and injuries with joint based swelling, like knee osteoarthritis, or acute tendon flare ups.

They don’t work well on non-inflammatory conditions, like calf muscle tears.

Interestingly, they work ridiculously well on the symptoms of bone stress injuries. NSAIDs will block out almost all of the bone stress pain, while the bone deteriorates and gets worse…

The negatives are numerous though.

NSAIDs have been shown to adversely affect the gut (particularly in high doses and prolonged use).

They increase bleeding in the first few days after acute injury, so that swollen ankle will swell even more…

And they inhibit the body’s ability to repair itself (especially important after soft tissue damage or bone injuries).

Because of all the negatives, they should only be used after consulting a pharmacist to discuss your risk factors.

If you have the option of heat or ice instead of anti-inflammatories, it’s best to try those first.

Which should I use – heat or ice or meds?

Now that you know the pros and cons of each option, here are some guidelines on which one to use.

Answer each question down the page and click on “YES, read on” or “NO, skip ahead” to move to the appropriate section displayed at the top of your screen.

Was the injury was caused by a single incident (eg. Rolled ankle)? If YES, read on to the next question. If NO, skip ahead to gradual onset injuries.

Have you got swelling and/or bruising? If YES, read on. If NO, skip ahead.

You have swelling and/or bruising.

  • Use ice packs or ice immersion (for approx 10min every few hours) and compression for 3-7 days
  • Use compression around the area, like an elastic bandage
  • Avoid anti inflammatory meds as they increase bleeding 

You have no visible swelling or bruising.

  • Use heat or ice (for approx 10min every few hours) for 3 days
  • Compression isn’t required but may make the injury feel more secure

Your pain started gradual over a period of days/weeks.

Is there visible swelling? If YES, read on. If NO, skip ahead.

You have visible swelling.

  • Use ice or anti inflammatory meds (if approved by your Pharmacist) daily and after exercise
  • Compression around the injury can be helpful
  • If it’s not responding after 5-7 days, seek medical assessment

Do you experience stiffness after rest (such as on waking in the morning)? If YES, read on. If NO, skip ahead.

You’re experiencing stiffness after rest. We recommend:

  • Anti inflammatory meds are usually effective when used daily or in the evening for a few days (check with your Pharmacist first)
  • Heat or ice before bed can also be helpful (10min, applied once or twice in the hour before sleeping)
  • If it’s not responding after 5-7 days, seek medical assessment

You don’t have swelling or stiffness so it’s unlikely that heat or ice or anti inflammatory meds will be helpful other than to sooth the pain temporarily.

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