Managing Ankylosing Spondylitis Pain: Ice or Heat Therapy?

Ankylosing Spondylitis: Ice or Heat Therapy?

Hello, Doctor.
Recently, I have experienced a relapse of ankylosing spondylitis (which has been symptom-free for over three years).
Since entering the workforce, I have also been exercising very little.
I am experiencing severe pain in my right sacroiliac joint, making it difficult to get out of bed and walk.
I would like to ask if I can use ice packs or heat packs? I have found a lot of information online, but it seems to be divided into two camps: one says to use ice packs for acute and severe pain, while the other claims that after six hours, ice can hinder recovery and that even in cases of acute pain, ice should be avoided, suggesting that heat is better for conditions like rheumatoid arthritis.
I am quite confused, so I decided to ask a professional doctor directly.
What should I do to effectively reduce the pain without causing harm to my body? Thank you very much! P.S.
Currently, I hope to avoid medication; ten years ago, I improved significantly through increased physical activity (playing sports).
Thank you, Doctor!

Mr. Hsu, 30~39 year old female. Ask Date: 2017/07/17

Dr. Gao Jiankai reply Internal Medicine

Hello Mr.
Hsu, thank you for your question.
The location of the sacroiliac joint is relatively deep, so the effectiveness of ice therapy may be limited; heat therapy might be more beneficial.
Regarding the choice between heat and cold therapy, I believe that during the acute phase, ice therapy can indeed be helpful, especially when you feel warmth in the joint; applying ice can more effectively alleviate pain.
However, ice therapy is primarily a choice for the first day of joint pain, and for the future repair of joint inflammation, heat therapy will be necessary.
As for whether ankylosing spondylitis can be managed solely through exercise, I personally think it is essential to consider clinical symptoms and laboratory results.
If your inflammatory markers are excessively high and the joint is inflamed, forcing yourself to exercise may worsen the arthritis and may not yield optimal results.
Anti-inflammatory and analgesic medications can reduce inflammation, making exercise more enjoyable, creating a positive feedback loop, and subsequently decreasing the need for anti-inflammatory medications.
Elevated inflammatory markers can also affect blood vessels and organs, increasing the risk of early vascular sclerosis, cardiovascular diseases, and cerebrovascular diseases, so controlling inflammation with medication is necessary.
Therefore, in addition to your personal choices, I recommend regularly monitoring your inflammatory markers as a reference for your physician's treatment decisions.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is concerned about your well-being.

Reply Date: 2017/07/17

More Info

Managing pain associated with Ankylosing Spondylitis (AS) can be challenging, especially when considering the use of ice or heat therapy. Both modalities have their benefits, and the choice often depends on the specific symptoms and the stage of the condition.

Ice Therapy
Ice therapy, or cryotherapy, is typically recommended for acute pain and inflammation. When you experience a flare-up of AS, especially with significant pain in the sacroiliac joint, applying ice can help reduce swelling and numb the area, providing temporary relief. Ice works by constricting blood vessels, which can decrease blood flow to the inflamed area, thereby reducing inflammation and pain. It is generally advised to apply ice for 15-20 minutes at a time, ensuring that there is a barrier (like a cloth) between the ice and your skin to prevent frostbite.

Heat Therapy
On the other hand, heat therapy is often recommended for chronic pain and stiffness associated with AS. Heat can help relax and loosen tissues and stimulate blood flow to the area, which can be beneficial for muscle relaxation and pain relief. Applying heat can be particularly effective in the morning or after periods of inactivity when stiffness is most pronounced. Heat can be applied using heating pads, warm baths, or hot packs, and like ice, it should be used for about 15-20 minutes at a time.

When to Use Each
The confusion often arises because the choice between ice and heat can depend on the timing and nature of the pain. Here are some guidelines:
1. Acute Pain (Recent Onset): If your pain is sudden and severe, ice is generally the better option. It can help manage inflammation and provide immediate relief.

2. Chronic Pain (Long-standing Issues): If you are dealing with ongoing stiffness or pain that has been present for a while, heat may be more beneficial. It can help improve flexibility and reduce muscle tension.

3. Post-Activity: After physical activity, if you feel soreness, a combination of both may be effective. You might start with ice to reduce any inflammation and follow up with heat to help relax the muscles.

Additional Considerations
- Listen to Your Body: Everyone's response to ice and heat can vary. If one method exacerbates your pain, it’s best to switch to the other.

- Consult a Professional: Since you mentioned that you prefer not to rely on medication, consider consulting a physical therapist. They can provide tailored advice and may suggest specific exercises that can help manage your symptoms effectively.

- Exercise: Regular, low-impact exercise is crucial for managing AS. Activities like swimming, walking, or cycling can help maintain flexibility and reduce stiffness. It’s important to find a balance between rest and activity.

Conclusion
In summary, both ice and heat can play important roles in managing pain associated with Ankylosing Spondylitis. Ice is typically used for acute pain and inflammation, while heat is more beneficial for chronic stiffness and discomfort. It’s essential to pay attention to your body’s signals and adjust your approach accordingly. If symptoms persist or worsen, seeking medical advice is crucial to ensure that you are managing your condition effectively and safely.

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