To 'heating pad' or not to 'heating pad', that is the question . . .

Heat it if you must, . . . but NOT ALL NIGHT LONG.

This phenomenon has a few times come through my office in the last 20+ years. I remember my teachers in Chiropractic school talking about this. I was amazed at its accuracy the first time I came across it. . . and every other time as well.

(Are you curious, yet?)

The general consensus of the medical world (but not my view) is that when you have an injury you alternate the use of 20 minutes of ice and 10 minutes of heat on the area. (The numbers may vary a little, but that is the idea.) Why? Let's talk.

Numbing the pain

Injuries hurt. (Ya think?) Most people don't like pain. (Ya think?) Therefore, their objective becomes to get out of pain. The doctor can give you a variety of ways to do this, depending on the application. Pain killer pills, anti-inflammatory pills, cortisone shots, heat, ice, and maybe more. Heat is the subject of this post.

Reducing the swelling

Tissue gorups are generally in balloon type packages, which are generally in larger balloon type packages. (Connective tissue is a medical term you may have heard a lot.) When there is an injury, there are microscopic (or larger) tears in the injured tissues. (Read 'tear' as a rip, not as the water coming out of your eyes, although that may happen after an injury as well.) There is fluid in and around all our tissues. With these tears, the fluid leaks out of the injured tissues. (OK, so that is similar to the water coming out of your eyes. Who knew the word 'tear' would have such a cross-over definition!)

So when the fluid is leaking out of these torn tissues, the balloon type package stretches. In the tissue of this connective tissue balloon type  package are nerve endings that register the stretch. Some of these are called 'nociceptors.' Noci- means pain. So these nerve endings are 'receptors' of 'pain'. Therefore the stretching of this balloon package registers as pain. The more you swell, the more you stretch, and the more you feel pain.

That is why they tell you to ice.

Huh?

Blood flow

When you decrease the speed of the blood traveling through the area, you decrease the volume of fluid going into the area (in a given time period). Less blood flowing through the area means less fluid entering the cell areas, resulting in less that leaks out into the stretching balloon package. Thus, you have decreased swelling and decreased stretch, resulting in decreased pain.

Ice will decrease the blood flow, i.e., the volume of blood flowing through the area in a set amount of time. It seems like a happy fix.

But if you leave the ice on too long, you will do that frost-bite thing, so they tell you only 20 minutes. That is also why they tell you to use the heat on it for 10 minutes between the icings-to undo the frost-bite thing.

However, heat will increase the blood flow.

Heat feels better

Both heat and ice numb the nerves. And we all know that heat feels better than ice. And a heating pad doesn't cool off like a hot water bottle. So, the ideas begin to churn in our head...

Here is the point of my post. (Koodos for you if you've stuck with me all this time!)

Because we are in pain, and because heat feels better than ice, and because heating pads feel better than hot water bottles, sometimes people take their heating pad and sleep on it ALL NIGHT LONG.

Please remember back to the discussion about the torn tissues having their fluid leak out, and that increased blood flow (caused by the heating pad) keeps bringing more fluid in the injured, and all that 'more fluid' will continue to leak out, filling up and stretching the balloon package, which then continues to stretch the nociceptors . . . ALL NIGHT LONG.

But you say, "I don't feel pain all night long when I am on my comfortable heating pad. In fact, I feel good."

Now I ask you to also remember the discussion of heat numbing the nerves. That includes the nociceptors. So when you get up in the morning and a little time has gone by to let the numbing effects of that all-night cozy heating pad wear off - - you are still left with a very stretched balloon package firing lots of nociceptors . . . ALL DAY LONG.

The final effect is an injury that never seems to feel better. The pain is as severe the 14th day as it was the first day. Typically, and the cases I've seen, it is 10-14 days before they see their Chiropractor. They are perplexed about why it is not getting better (in spite of the pills they are taking). Initially the all-night heating pad came out in the conversation accidentally. Now, I know to ask about it specifically.

There you go. Now, not only do you know what to do and not do, but also why.

So, Heat it if you must, . . . but NOT ALL NIGHT LONG!