Should I Use Heat or Ice?

Deciding whether to use heat or ice for an injury can be a confusing topic for many people. With so many varying opinions and recommendations, it’s important to remember that every body and injury is unique, and what works for one person may not work for another. That being said, let’s discuss some general guidelines for using heat or ice.

It’s important to remember that heat or ice should never be used as the sole means of treating an injury. Instead, they should be used in conjunction with therapeutic exercise and activity modification to reduce symptoms. The main effect of heat or ice is symptom reduction, achieved through blood flow changes, lymphatic changes, or neurological sensation changes.

In general, we use tissue healing time to determine whether ice or heat is best for a patient. During the acute phase of an injury (0-7 days), ice is typically most beneficial. As the body transitions to the subacute phase (3-21 days), heat becomes more helpful, and for chronic pain (greater than 21 days), heat application is usually most effective. However, if these time frames don’t match your specific pattern, or if you feel greater relief with one method over the other, it’s important to listen to your body.

The Visual Analog Pain Scale (VAS) can be a helpful tool in determining whether to use heat or ice. If your pain is rated 7-10/10 on the VAS scale and described as “sharp/stabbing/intense,” ice is likely to provide the most relief. If your pain is rated 1-6/10 and described as “tight, stiff, achy, spasm,” heat may be more effective.

Here are some guiding tips for using ice:

  • Use for injuries that have been felt for a short duration (0-7 days)
  • Use for recent surgical interventions
  • Use for injuries that are hot to the touch
  • Use for pain rated 7-10/10 on the VAS scale

Here are some guiding tips for using heat:

  • Use for injuries that have been felt for 7-21+ days
  • Use for surgical interventions that occurred at least 4 weeks ago
  • Use for injuries with no temperature changes to the touch
  • Use for pain rated 1-6/10 on the VAS scale

When using heat or ice, it’s important to only apply them for 10-20 minutes at a time and to always use a barrier between the agent and your skin to prevent burns and frostbite. There are also some cases where heat or ice should not be used, such as for skin rashes, open wounds, impaired cognition, neuropathy, or peripheral vascular disease.

Ultimately, the goal is to no longer need heat or ice at all. To achieve this, it’s important to work with a licensed physical therapist to determine the underlying cause of your symptoms and develop an individualized treatment plan. Remember, there is no one-size-fits-all approach to pain management, and it’s important to find what works best for your unique body and injury.