Ice or Heat: The Great Debate

The Great Debate: Should I use ice or heat for my injury?

Often we are asked this question, and despite conflicting evidence regarding this topic, there are general guidelines which will help you choose the correct modality!

Indications for using ICE:
1. Acute (less than 72 hours) onset – ice will be your best bet at reducing potential side effects that normally develop following an injury.
2. Pain/inflammation/swelling/tenderness/warmth/redness – if your injury resulted in any of these conditions, and is persisting even after the acute onset, ice can help reduce your discomfort by means of vasoconstriction (the narrowing of blood vessels to reduce the amount of blood flow to the injury site). Inflammation is a NORMAL response to injury to allow for initial healing of the injured tissue, but if it becomes chronic in nature, it can actually cause long term damage of that same tissue!
3. Post treatment/exercise/athletics – ice is effective at reducing the delayed onset of muscle soreness, or DOMS, that you probably have experienced 2-3 days post exercise/athletic endeavor. This will allow you to tolerate high intensity activity on a more frequent basis without the discomfort from your last outing.

Guidelines for ICE use:
Apply ice (bagged, gel pack, wrap, etc.) wrapped in a thin towel to the joint/muscle/tissue for 15 minutes at a time, as often as every hour (15 minutes on, 45 minutes off). Continue to use ice until your pain and inflammation have subsided.

Indications for HEAT:
1. Chronic (long withstanding) onset – injuries that do not present with pain/inflammation/swelling/tenderness/warmth/redness and have been ongoing for extended periods of time.
2. Stiffness/soreness/tightness – any of these symptoms at a joint, muscle or surrounding soft tissue can be reduced with heat application by means of vasodilation (the opening of blood vessels to increase the amount of blood flow to the injury site).
3. Pre treatment/exercise/athletics – heat can increase the elasticity of the underlying tissue that may be causing your symptoms and allow for increased range of motion and flexibility. This will increase the joint or muscle’s effectiveness when called upon to perform an activity.
4. Osteoarthritis – studies have shown reduced pain, improved function and improved general health perception with the use of heat applied to arthritic joints!

Guidelines for HEAT use:
Apply moist heat (towel, compress, wrap, etc.) wrapped in a towel the joint/muscle/tissue for 15 minutes at a time prior to your activity of choice, or first thing in the morning if you have been diagnosed with arthritis.

Dr. Dustin Szenderski DPT