My niece is living with me right now and woke up Monday with acute knee pain after a big hike in the mountains on Sunday. She asked me if she should use heat or ice. People ask me this question every day, hey doc what should I use, ice or heat? This question always brings up debate.

Like I told my niece, when tissue in our body get injured, cells die, and the signals go out in full force through the blood. Mast cells release histamine to make the blood vessels and capillaries leaky so white blood cells can leak out of the blood and into the tissue to clean up the debris, wall off the injury, release fibrin and other connective tissue cells and fix what ever is broken. The cool thing is you don’t need to know that for it to work perfectly. As you can see inflammation is part of the healing. By the way, my niece has a little tendonitis on the quadriceps muscle. No big deal.

Acute injury creates inflammation. Inflammation has 4 features: heat, redness, swelling and pain. Heat is in the equation, so ice would feel good and do well. In Chinese medicine, the idea of yin/yang is generally treating the symptom with the opposite. Acutely, in the first 24-48 hours, ice will help with pain, swelling and redness. It will help slow down the leakiness of the blood vessel. My niece knew this, applied it and felt better. 15 minutes every 2 hours will work.

What do you use when you have had a problem for a long time, like low back pain? In my practice I use physiological principles of the body and yin/yang principles, again from Chinese medicine. When a problem has been long standing, things get stagnant and needs more blood flowing. Heat opens the blood vessels to bring fresh blood, oxygen, nutrients, wash debris away, increases the cellular metabolism. Sounds good to me, plus most people prefer heat. What kind of heat you ask, moist heat, something damp, for about 15-30 minutes.

In a recent study, researchers examined the effectiveness of heat or cold treatment for low back pain. A total of 1,117 patients were involved in the study, with various forms of heat and cold therapies used for different lengths of time. Results showed that the use of heat was effective in treating back pain. In two studies of people with acute and subacute low back pain, heat wrap therapy significantly reduced pain after five days compared to a placebo. In another study, people with acute low back pain treated with a heated blanket reported a significant reduction in pain immediately after the blanket was applied.*

Sounds like heat is the winner. In the practice, I also like to uses heat on for 1 minute, ice for 1 minute for several intervals. For thing like tennis elbow, ice massage can be great. Fill a small dixie cup, ¾ full and freeze. Tear off the top and apply with a circular massage motion. Try all of these things, see which helps you the most. The bottom line, is do what makes you feel the best. Listen to your body.

Keep in mind this publication is solely meant to be informative and entertaining and not an alternative to proper medical diagnosis or treatment. Seek proper medical care if you have any symptoms.

And look for a Second Opinion next week.

*French SD, Cameron M, Walker BF, et al. Superficial heat or cold for low back pain. The Cochrane Database of Systematic Reviews 2006, Issue 2. DOI: 10.1002/14651858.CD004750.pub2.