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As a licensed physical therapist, I have been asked about ice versus heat many times. “When should I use ice?” “When should I use heat?” “What about IcyHot?” Then, there are the patients with pulled muscles who ask me, “Should I try to stretch it?” So, ice versus heat: which should you be doing? Well, it depends.

When to Use Ice

As a general rule, I advise using ice for any acute injury (injury occurring within the last 48-72 hours.) Ice will control the inflammation and prevent a muscle or joint from becoming so puffy and stiff that it cannot heal properly. Now, there are some people in the world of sports medicine who will argue against the use of ice because they believe inflammation is part of the natural healing response. This is absolutely true, however,the inflammatory process occurs immediately; so even the fastest application of an ice pack will not beat this natural inflammation.

Applying ice simply prevents the natural inflammation and swelling from becoming excessive and potentially causing secondary tissue death, which happens when there’s so much swelling that blood flow is completely blocked and healthy tissue becomes hypoxic. In clinical practice, uncontrolled swelling turns into pitting edema (a thick, putty-like substance that leaves an indentation when you press on the tissue.) This in turn leads to a stiff and—what I describe as,—“sticky” muscle or joint.

If your injured area is s hot, swollen or painful, ICE IT. Crushed ice is the best at reducing tissue temperature since it undergoes an actual physical change (from a solid to liquid.) But be warned:ice burn is a real thing, and I usually see this with the use of gel packs. To avoid ice burn, use a pillowcase as a barrier between the skin and gel pack. Ice for 10 to 15 minutes at a time. For a brand new injury, ice can be applied hourly.

When to Use Heat

For anything that is stiff, tight or sore, I typically recommend heat. This usually applies to chronic and ongoing injuries – the neck or low back pain after a long day of sitting, or shoulder pain after working on the computer. Heat increases blood flow, relaxes muscle and makes the other fascial tissues more pliable (i.e. the joint capsule.) Physical movement or exercise is actually the best way to increase tissue temperature because your body is warming from the inside. Yes, believe it or not, gentle exercise (walking, stationary cycling, etc.) will actually do more for you than a heat pack.

IcyHot and other topical heat rubs targets the superficial sensory nerve fibers to create the sensation of cold or heat, which can reflexively cause muscle relaxation by inhibiting pain. Does it help with healing? No, but it doesn’t hurt either. Know that there is no magic solution.

Whether you are using ice or heat, , ice and heat application should be part of an all-encompassing rehabilitation program – including soft tissue mobilization, strengthening and re-training of motor control and movement patterns.

Pulled Muscles: Stretch or Don’t Stretch?

First off, you should always do a proper warm-up and cool-down to help prevent pulling a muscle in the first place. However, if you have a pulled hamstring or strained calf, DO NOT stretch it. You should never try and stretch an already over-stretched muscle.. A muscle strain occurs when the muscle fibers are pulled beyond their ability to recoil properly, so they snap back. Yes, I know it’s tight, but if you pull on (stretch) it,  the muscle will only continue to tighten and add to the current strain.

Instead of stretching it, now would be an appropriate time for ice, and in a couple of days you can start heating, foam rolling and stretching. If you have any doubt, you can schedule an evaluation with your Rausch physical therapist who will  assess the severity of your injury and let you know  when you can start stretching it, as well as help you to strengthen the area to prevent straining the muscle a second time.

Jessica Snyder (PT, DPT, ATC, CSCS) received her Doctor of Physical Therapy degree at the University of St Augustine for Health Sciences – with an emphasis on orthopedics, movement science, and manual therapy. Jessica started her career as a Certified Athletic Trainer working with high school, college and professional athletes. She is also a Certified Strength and Conditioning Specialist (enhancing her ability to build custom strength, stability and performance-centered rehabilitation and return-to-sport programs) and Certified Natural Running Coach. Being a runner herself, Jessica specializes in running-related injuries, including the entire lower extremity. She is also passionate about treating headaches and neck/shoulder pain.