The answers to the age-old questions still seem to elude so many of my patients. “When should I use ice? When is it better to use heat? Should I alternate between the two? Why is Dr. McCauley so freakin’ cool?” Fortunately, three of these questions are easy answers, but the latter, unfortunately, remains an enigma.

When in doubt LEAVE IT ALONE! Contrary to popular belief, the human body actually does know what it’s doing. We call that Innate Intelligence, the inborn ability of the body to react to a stimulus and heal itself.

That being said, the general rule of thumb is that ICE should be used for ACUTE injuries. That is to say, any injury newer than 72 hours. Let’s say you roll and sprain your ankle. It swells, turns red, gets warm, and the range of motion drops to just a few painful degrees. Why? This is the bodies response to the injury that resulted in an unstable joint. Inflammation causes fluid to enter the joint, taking up space, and creating something of a natural cast. This is the edema that causes swelling. Using ice will reduce the inflammatory process, bringing down the swelling and decreasing pain. Remember, anytime you hear the suffix -itis, that means inflammation, and ice is absolutely the correct choice when dealing with soft tissue. Bursitis, tendonitis, etc. are all times for ice. 20 minutes on/40 minutes off.

So if ice is used for acute injuries, then I guess HEAT should be utilized for CHRONIC injuries? Correct. Long-standing pain in muscles and joints can be alleviated thru heat by allowing more blood to enter the affected tissue. This makes heat perfect for long-standing muscle strains and arthritis. Now wait right there Doc, arthritis absolutely has the suffix -itis and you’re telling me to use heat? That’s correct, as with everything in life there are exceptions to the rule and arthritis just so happens to be one of them. 20 minutes on/40 minutes off.

And finally, we come to the ever-popular CONTRACT THERAPY, alternating between hot and cold. This is a spectacular way of pumping lymphatic fluid and increasing overall global circulation, but it offers very little if any benefit to local injuries. So, unless you plan on sitting in an ice bath up to your chin for 1 minute and then jumping into a hot tub for 3, best to stick with one or the other. If you do decide to give it a go, please make sure that your heart, liver, and kidneys are up to the task.

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