Ice vs. Heat – Which one do I use and why?

In physical therapy, we often recommend that our patients use either ice or heat as an adjunct to their treatment, but which one should you use and why?

In some cases, one is preferred over the other, but often, it comes down to personal preference.

Reasons to use ice to treat pain or injury:

1. Decrease inflammation

2. Decrease pain/numb the area

3. Decrease muscle spasm

4. Calm tissues down after potentially aggravating activities

In the case of an acute injury (i.e. ankle sprain), ice is always recommended over heat for the first few days following the injury. With an acute injury often comes swelling. When swelling is present, the healing process for the tissues is delayed. In order to decrease swelling in an area, ice is preferred for its effect on restricting blood flow to the affected area. You may also choose to use ice to decrease pain or muscle spasms. Generally, ice is also recommended after performing exercise or activities that may potentially be irritating to the tissues, or at the end of the day to help calm the tissues down.

You can use an ice pack by applying it to the affected area for 10-15 minutes. Always make sure to keep a thin layer of fabric like a t-shirt or a pillowcase between the ice pack and your skin to protect from frostbite. Wait at least an hour before applying ice to the area again.

Reasons to use heat to treat pain or injury:

1. Improve soft tissue mobility

2. Increase blood flow

3. Decrease muscle spasm

4. Warm-up tissues before activity or exercise in order to increase extensibility

Generally, heat is recommended in cases where we want to improve blood flow to the affected tissues. If you are experiencing chronic muscle stiffness, for example, heat may be a good choice to help warm up the muscles and joints before engaging in exercise or other activities. Warming up the tissues, along with use of prescribed stretches and exercises from your physical therapist may help decrease risk of injury by improving tissue extensibility before performing the task at hand. Heat may be a good choice to use first thing in the morning to help your joints and muscles warm up for the day.

To use heat, simply apply your heating pad to the affected area for 10-20 minutes. If you are using an electric heating pad, please make sure not to fall asleep while using the heat to help ensure safety. A good option might be a microwaveable rice or corn bag that will gradually cool down over time. Make sure the heating pad is not too hot before applying to protect your skin from burns.

Please remember that these are all general recommendations, and what works well for some may not work well for others. If you have any questions or are experiencing any injuries that aren’t improving with use of heat or ice, please make an appointment with a physical therapist at Performance Therapies for further evaluation.

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