Ask the Therapist: Heat or Ice?

Heat or ice? It’s one of the most common questions we receive. While it is difficult to generalize all pain and injuries, there are a few simple rules that you can follow to help in your recovery.

Ice is most appropriate for initial (or acute) stages of an injury. Ice helps control pain levels and constricts the blood flow to areas around the injury. This decreases the amount of particles that promote inflammation at the site of the issue. Inflammation is an important part of the healing process initially, but can be more damaging if it continues to linger.

During the first week or so after an injury, icing is usually appropriate to promote healing. Try icing for 10 to 20 minutes (or until the area is numb). You can ice multiple times during the day, especially early on in the healing process. If you have any issues with cold sensitivity or have decreased sensation in the painful/swollen area, ice may not be a good choice. If you notice any irritation to the skin that lasts for longer than expected or increases your pain, stop using ice immediately.

Ice during later stages of healing may actually hinder the healing process because it constricts the blood flow to tissues in need. Instead of icing, using cold packs for shorter periods of time are more beneficial for pain reduction without the negative side effects. At the later stages of healing, heat and appropriate exercises to bring additional blood flow to the area are more appropriate.

Heat becomes more appropriate once the acute stage of the injury has passed (sub-acute or chronic). Heat is used to help promote blood flow, improve tissue mobility and decrease pain levels. Despite not reaching very deep, heat has mechanisms that can reduce painful stimuli and allow for relaxation. Try heat for 10 to 20 minutes depending on your comfort level. The same precautions for ice apply to heat – stop immediately if you notice any sensation issues, redness or large amounts of swelling. You should not use heat during the initial stage of an injury. This can cause increased swelling which can further damage the natural healing process of tissues.

In cases of longstanding pain, such as low back or neck pain, we can disregard everything that was previously stated.  These chronic types of pain are not related to a specific injury or event and the normal, natural healing process is no longer active.  Therefore, it is safe and appropriate to try heat and/or ice to see which provides the most relief. At this stage, they are used solely for pain relief. As a general rule, heat prior to activity helps with motion and tightness while icing after activity helps reduce soreness, aching, or throbbing pain. But really, try one, and if it does not work, try the other.

At the right time, heat and ice will both allow for pain relief.  Also, in the right situation they can help injured tissues heal. Be sure to consult your physical therapist with additional questions or concerns specific to your injury and the best modalities to help with your recovery and symptoms.