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Heat or Ice?

One of the questions that I am most often asked by my patients being treated for pain is, "Should I apply ice to my injury? Or should I apply heat?" I find that all too often many health practitioners believe that icing injuries is a cure-all for pain relief without taking into consideration that icing injuries can negatively impact the healing process. I'd like to offer up my philosophy on this topic, and tell you why always icing injuries isn't nearly as helpful as people are led to believe.

From a biomedical, or Western, perspective, when the body is injured one of the first things that occurs is swelling, redness, soreness and heat around the injured area. Discoloration or bruising of the skin can also take place during this time, as well as a loss of range of motion. This ‘acute stage' is usually the first 48 hours following an injury. From a Traditional Chinese Medicine perspective, this would be known as the Yang stage of injury.

After the initial 48 hours have passed, the swelling has usually subsided considerably, the redness has lessened, and although the pain is still there, it's not nearly as bad as it was initially. At this point, your injury has moved into the ‘chronic' stage. At this stage the actual healing begins to take place. It's during this time that the body works to re-direct blood flow back to the area by pumping in red and white blood cells to help repair and regenerate the injured tissue. From a Traditional Chinese Medicine perspective, this is known as the Yin stage of injury.

The foundation of Chinese Medicine is based on the concept of Yin and Yang. In a nutshell, Yin and Yang represent balance. One balances out the other: Female to Male, Night to Day, Moon to Sun, and Dark to Light. The acute stage of injury can also be seen as the Yang, or HOT, stage of Injury much as the chronic stage is also seen as the Yin, or COLD, stage of Injury.

For that early Yang stage, icing is most beneficial because it helps reduce swelling. That's what cold does - it slows down molecules, and causes things to contract.

However, once you have moved into the chronic Yin stage, (after the first 48 hours) icing an injured area is actually detrimental to healing. Converse to how cold causes contraction, heat causes expansion and encourages molecules to move more quickly. In terms of your physiology, heat causes blood vessels to dilate, and allows more blood flow to an area, resulting in faster tissue repair and restoration. In the case of chronic low back or neck pain, the pain is most often a result of constantly tight and constricted muscle tissue. The muscle fibers and the surrounding vasculature are starved of fresh oxygenated blood supply due to constriction. Administering heat to these areas will be far more beneficial to your healing process compared to applying ice.

My general rule of thumb for patients is this: For the first 48 hours following an injury, and when swelling and redness are present - Ice. Once the swelling is no longer present (or if there was no swelling there to begin with) and the skin coloring has returned to normal - heat therapy is far more beneficial in your efforts to heal the injury.

Jonathan Dodds, Lac is a licensed Acupuncturist at the Snohomish Naturopathic Clinic. Jonathan earned his Masters of Science in Traditional Oriental Medicine from the Pacific College of Oriental Medicine in San Diego. He completed further training in Diabetes and Chinese Herbology at the Chengdu University Hospital of TCM in the Sichuan Province of China. Jonathan has undergone extensive training and specializes in the areas of Orthopedic Sports Medicine and pain management, and is a highly trained Herbalist who includes the use of Chinese Herbs in his treatments whenever possible. For more information visit


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