One item of contention between practitioners of Western and Eastern medicine is whether to use heat or ice on an area of pain. Whether the pain be acute or chronic, the standard line from most chiropractors, physical therapists, and doctors is to put ice on the affected area. We are told that cold reduces swelling and to avoid heat as pain is typically marked by inflammation, a component of which is heat.
I have had many patients over the years who have been given this advice and suffer needlessly as the application of cold worsened their pain. They grin and bear it because they assume their healthcare practitioner knows best, even as their body’s wisdom presents evidence to the contrary. Furthermore, we have been indoctrinated with the notion of “no pain, no gain” that has no business extending into the areas of medicine and wellness.
So what is the Eastern view on heat versus cold? Categorically, practitioners of Chinese medicine recommend heat, even for acute injuries, and warn against the use of cold. In general, heat engenders movement and increases circulation. Cold does the opposite, slowing down movement and impairing circulation.
The first point of contention then becomes whether we should ever be impairing circulation. In the case of an acute trauma marked by a lot of swelling, the Western response is to reduce that swelling to mitigate pain. Take for an example an ankle sprain. Elevating the foot and icing the area does reduce the swelling and pain, but have we helped the ankle heal in the process? Swelling occurs for a reason and is well within the body’s design. Swelling dramatically increases surface area and circulation, allowing your immune and repair systems to work optimally. In addition, swelling is a clear and unambiguous message from your body to sit on your duff and rest. Icing your ankle so you can “get back in the game” is never what your body has in mind.
A second problem arises with repeated use of ice over the same area. Chinese medicine teaches that application of cold is a causative factor in one particular type of arthritis. Just as surely as heat speeds up the movement of molecules and improves circulation, cold slows the movement of molecules, or in the case of water becoming ice, suspends them altogether. Early in my practice I had this point driven home when a man in his 50’s presented with a diagnosis of left ankle arthritis. As a high school football player, he sustained multiple sprains to this ankle, treated by prolonged soaks in ice baths before returning to the field. Acupuncture was palliative to treat his chronic pain but the addition of heat therapy to the ankle was curative. From the traditional Chinese medicine viewpoint, circulation in this gentlemen was impaired by cold to the point that arthritis appeared in that joint around middle-age. Using heat to “chase out” the cold proved to be the most effective therapy.
Finally, the notion to avoid external warmth with inflammation, as if it would somehow add to or outright cause inflammation is absurd. If heat caused inflammation, people would exit from a sauna riddled with pain. Your body turns up the heat in the form of acute inflammation to help repair tissue. Chronic low-grade inflammation is a separate pathological process which must be treated differently, but even then, heat does wonders in the topical treatment of chronic pain and inflammation.
Beyond the traditional viewpoint, research evidence within conventional medicine suggests that ice on soft tissue injuries is indeed efficacious for pain relief but offers questionable benefit to help heal the area.
Ultimately, the best advice is to trust your body and do what feels best. There are certainly times when ice not only feels better but does hasten healing, but I would argue that those instances are few and far between. In consulting with patients, most will be using ice and not enjoying the experience, only to report that a hot shower alleviates their pain and relaxes the area. Your body will tell you what serves you and what does not apply so be open to your innate wisdom and let the heat in.
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