Ice vs. Heat: Which should you use and when?

As a physical therapist, I usually try to address the cause of the pain someone is having. Knee pain usually means hip and glute strengthening is needed. Shoulder pain often originates from poor shoulder mechanics, shoulder blade weaknesses, and postural deficits. However, the immediate pain a person is experiencing also needs to be addressed. We cannot work on strength and muscle imbalances until the person has pain free motion and is able to perform the recommended exercises. I believe gentle movement is one of the best ways to work towards pain free mobility, but sometimes we need a targeted treatment directly over the painful area especially if the injury just happened. One of the easiest ways to do this is by applying ice or heat. Both ice and heat decrease pain, but the reasons for choosing one over the other are quite different and very important.

Here is a breakdown of the two: 

Ice

  • PROS:
    • Decreases pain
    • Decreases swelling
    • Decreases inflammation
  • CONS:
    • Decreases flexibility
    • Increases stiffness
  • USES:
    • Acute pain
    • Acute swelling
    • Acute inflammation
    • Post-exercise
    • Delayed onset muscle soreness
  • ADJUNCTS:
    • Compression
    • Elevation

Heat

  • PROS:
    • Decreases pain
    • Increases tissue flexibility
    • Decreases stiffness
  • CONS:
    • May increase swelling
  • USES:
    • Chronic pain
    • Pre-activity
  • ADJUNCTS:
    • Massage

It is important to note, you typically would not want to use heat or ice if there is an infection, any open wounds, and/or the individual has decreased sensation over the area.

SO - should you use ice or heat?

I generally start with ice, especially if there is a recent injury. For example, you would use ice for an ankle sprain and immediately following a surgery.

If there is chronic pain or the pain is due to muscle tightness, then I suggest heat. For example, you would typically use heat for longstanding low back pain or neck pain from poor posture.

If you start with ice, you can switch to heat when the swelling is controlled, motion deficits are primarily limited by stiffness, there is normal skin temperature, and you are no longer getting improvements or benefits from ice.

The choice of ice vs. heat also comes down to personal preference. Sometimes I recommend ice, and the patient says absolutely no way – they hate ice. If after going over all of the benefits and importance of ice they still refuse, then it is what it is.

I personally like to use ice most of the time because it almost always decreases my pain and makes me feel better. Call me crazy, but most of my showers in the summer are cold and even in the winter I always end with a cold blast. It helps my muscles feels better especially after a workout. I also believe in ice baths, which are full submersion into ice-cold water. I often take ice baths after hard bouts of exercise such as a tough or long run. Here I am in a cold pool soaking my legs. Rivers work great for ice baths as well. It can be a shock at first, but it makes you feel so much better afterwards!

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I do use heat occasionally, but mostly only on my neck when it is tight and I feel like I need a massage. It is important to realize general exercise and mobility are excellent ways to supply warmth to your own body without using an external heat source. Heat increases blood flow to the area, but you can also do that by simply moving yourself if it isn't too painful. For example, shoulder rolls and neck circles within a pain free range are great alternatives to direct heat. In addition, riding a stationary bike is an excellent way to loosen up a tight and painful knee instead of using heat. Always consider exercise in lieu of heat for a full body effect and more widespread health benefits. After you exercise, then you can put some ice on! :)

What do you prefer – ice or heat?