Should I Use Heat or Ice?

Often times during therapy the use of heat or ice becomes a big topic of discussion. They often say, “My uncle told me he had this same problem and he put ice on it, and it went right away!” Almost every patient that comes through the door has either had a recommendation or googled about using heat or ice for an injury. Often times it can lead to frustration with varying opinions on which to use. I think it’s important to point out that every human body, pain experience, and injury are different in their own special ways. It is paramount that you find what works within your own body. However, for this blog, let’s discuss the age-old question…..heat or ice?

There are a few rules to follow when deciding whether or not to ice or heat an injury. Both of these modalities on their own are never a means to “cure” or cause any type of injury. I prefer to see them used as additional tools in your toolkit that, when used in conjunction with the proper therapeutic exercise and activity modification, can have large impactful changes to your pain experience. The main effect seen with the use of ice or heat is symptom reduction. This is done by creating either blood flow changes, lymphatic changes, or neurological sensation changes to reduce the pain being felt from one area of your body.

In general, often times we use tissue healing time to establish whether or not ice or heat would work well for a patient. We use three main phases of healing which are acute (0-7 days), sub-acute (3-21 days), and chronic (greater than 21 days). During the acute phase of an injury, it is likely that ice would be most beneficial and feel best for you. As your body then transitions to the subacute phase heating agents then become more helpful and beneficial, and then chronic pain usually feels best with heat application. Alternatively, if these time frames don’t seem to trend to your specific pattern or if you feel greater relief with one vs the other it is always important to listen to your body! That’s when it can be helpful to use the Visual analog pain scale (VAS – see below). In general, if you are experiencing pain levels 7-10/10 on the VAS scale and you describe your pain as “sharp/stabbing/intense” it is likely to respond best to ice for it’s vasoconstriction and numbing effects. If your pain levels range from 1-6/10 and are described as “tight, stiff, achy, spasm” then heat may work best for it’s vasodilating and parasympathetic nerve stimulation effects.


Here are a few guiding tips of ice application and when it may be applicable for you:
-Injury has been felt for a short duration (0-7 days)
-Recently had surgery
-Injury is hot to the touch
-Pain rated 7-10/10 on the VAS scale

Here are a few guiding tips of heat application and when it may be applicable for you:
-Injury has been felt for 7-21+ days
-Surgical intervention occurred at least 4 weeks ago
-No temperature changes to the touch
-Pain rated 1-6/10 on the VAS scale

Now let’s discuss ice or heat application. Typically, heat or ice only has to be applied 10-20 mins to have a therapeutic effect. This should always be paired with a solid barrier between the agent and your skin to prevent burns and frostbite. There are also some cases in which heat or ice should not be applied or should be used with caution:
-skin rash
-open wounds
-impaired cognition (E.g. dementia)
-Neuropathy (E.g. Diabetes)
-Peripheral vascular disease
-DOMS or delayed onset muscle soreness (not good or bad but just might be a waste of your time, but let’s save that for another blog!)

The main focus on improving one’s pain free mobility status is a multi-factorial approach. There is no “once size fits all” method. If you find yourself in a scenario in which you are outside the “acute” phase along with no recent surgical history you may trial both and see which feels best for YOUR body. We are all so uniquely different and experience pain in very different ways. Therefore, what feels good or works for one individual may not be the answer for you. That is why it is important to use the above information regarding heat or ice application in conjunction with scheduling an appointment with a licensed physical therapist to better assess the cause of your symptoms. This is the best approach when working with any type of pain. Working alongside a PT, it is important to come up with an individualized and tailored approach for what will reduce your symptoms long term. At the end of the day, the long-standing goal of all of this is to no need the ice or heat in the first place.