Heat vs Ice – The Great Debate



It’s not uncommon to have multiple questions relating to when you should use heat and when you should use ice. I’ve heard patients tell me that they only like heat for their injuries and others state that they notice the most relief with ice. While there is not a single “best” way to use these modalities, there are some good general guidelines to follow!

1. Chronic Pain vs Acute Injury – If you’ve recently injured yourself and have swelling, it is a general rule to always use ice. This acute injury typically presents with significant swelling and higher levels of pain. Ice will reduce blood flow to the injured region and allow the healing processes to start. An acute injury is normally defined as something that occurred within the last 48 hours. We want to avoid heat because it causes vasodilation, which leads to more swelling. You should avoid heat for at least 2 weeks after an acute injury. If you have chronic pain, it normally feels better to increase blood flow to the area and relax muscles, which is why heat is warranted. Since there typically isn’t swelling associated with chronic injuries, it is safe to use heat.

2. Relaxing vs Numbing – When you have tight or guarded muscles, we normally want to relax them with heat. Heat will ease tightness and soothe muscle ache. Ice or cold modalities will promote pain reduction by numbing and calming down the injured area. My recommendation is to use ice when you are noticing significant amounts of pain because this will help block and mediate pain receptors.

3. Low Back Pain – Is ice or heat best for low back pain? This is a hard question to answer because everyone responds a little differently. However, most low back pain is due to a muscle strain which normally responds best to heat. This is due to the heat improving blood flow and relaxing tight muscles. If you recently had back surgery though or suffered a new injury, ice might be warranted because of the swelling that may be present. If one works better for you than the other though, continue to use that modality!

4. Frequency and Duration – Typical duration for both heat and ice are 10-20 minutes, 1-3 times per day. We never want to place heat or ice directly on the skin unless specified by a medical professional. Using either a towel or pillowcase will suffice for skin protection. If you are experiencing any numbness and tingling in the injured area, always consult your medical professional because you could potentially suffer serious modality burns.

Hopefully this will answer your questions relating to when’s the best time to use ice or heat. Since there isn’t a “best” way to use these modalities, always consult your medical provider if you have any other questions or concerns!

– Dr. Colten Sullivan
Bull City Physical Therapy

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