To Ice or To Heat?
How to Choose Ice or Heat for Pain Relief
When dealing with musculoskeletal pain, there can be uncertainty regarding whether heat or ice is better for symptom management. Speaking with a healthcare provider for individualized guidance is ideal, however when more immediate remedies are needed, it is helpful to know which is best to administer to alleviate pain.
Ice Therapy (Cryotherapy)
One of the most well-known benefits of ice is inflammation control. Cryotherapy constricts the blood vessels around the area of application which decreases inflammation and limits bruising and swelling. Ice can also help numb the area, thus assisting with pain relief. Applying ice for 20 minutes at a time is generally recommended, then removing it for at least 20-40 minutes before re-applying.
Cleveland Clinic recommends using ice for acute injuries—that is, injuries less than 6 weeks old. These injuries can include ligament sprains, bruises, muscle and tendon strains, bursitis, and tendonitis. Ice is also recommended post-operatively, as orthopedic procedures often result in a significant increase in swelling and inflammation around the area.
Heat Therapy (Thermotherapy)
If your goal is to increase blood flow to the affected area and to promote muscle relaxation, heat is recommended. Heat can also be used before physical activity to warm muscles and loosen up joints, although an active warm-up is recommended as well for more strenuous activity.
For injuries and conditions that have lasted more than 6 weeks, heat is typically recommended. However, lingering inflammation should be considered, and alternating between ice and heat may be beneficial. The rule of thumb when using both heat and ice is “warm up, cool down”, meaning that you should start with heat and end with ice.
Contrast Bath Therapy
Contrast baths are an effective means by which inflammation and swelling can be reduced in your extremities. Injuries in the hands, wrists, feet, and ankles are the easiest to treat with this method, as it involves alternating between placing the affected extremity in basins containing hot and cold water. When you alternate between hot and cold in this manner, your blood vessels open and close, which is theorized to produce a pumping action that can help diminish swelling. Instructions for how to perform contrast bath therapy are detailed in the handout linked HERE.
Ice & Heat Packs
Soft gel packs are a preferred way to apply ice or heat at home, as they will contour to the affected area and can stay cold or hot long enough for the treatment to be effective. The product listed below can be used both for heat and cryotherapy and is sold here at Living Well.
In conclusion, ice is best for inflammation and swelling, while heat is best for increasing blood flow to the area of application. When the choice between the two is unclear, try whichever one seems to better fit your situation and see how your body responds. If the response is negative or even neutral, try the other option and re-assess. And of course, a healthcare provider such as a physical therapist or chiropractor can evaluate your condition and provide specific recommendations.
Dr. Katherine Reardon - DPT
Katherine, a California native, completed her Doctorate in Physical Therapy from the University of the Pacific in 2019. Before that, she attended California State University Stanislaus, where she graduated Summa Cum Laude with a Bachelor of Arts in Kinesiology, concentrating on Health and Wellness Promotion. Katherine's experience as a physical therapist spans both outpatient and inpatient settings, where she developed a strong interest in adult orthopedic conditions and post-operative rehabilitation.
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