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One of the most common questions that patients ask their physical therapist is “so, should I ice it or heat it?”. The answer to this question differs for each injury and each patient. Icing and heating are two very useful, cost-effective, and rational ways that my patients can manage their pain when out of the clinic. Because they are key to pain management and essential to the rehabilitation process, I find myself (as the PT) explaining to each patient the difference between icing and heating. Aside from the obvious – ice being cold and heat being warm – ice and heat differ in use and therapeutic effects on the body.

When should I ice or heat?

Ice is used for any acute injury. This means that ice is best for a new injury. Think of a swollen, red, and irritated knee – this kind of injury is the perfect match for ice. Ice has been known to decrease pain while also reducing inflammation and swelling. So when my patients walk into the clinic with a swollen, inflamed, or irritated injury, I will apply ice to the injury.

Heat is for chronic injuries. Heat is most useful when the pain has been ongoing over several days/weeks/months. Think of that dull achy back pain that has been present for months. The heat has been known to decrease pain while improving blood circulation to the heated muscle. I will apply heat to my patients that walk into the clinic with muscle aches, stiffness, or those with chronic pain.

When should I avoid ice or heat?

There are specific scenarios when you should not ice or heat. You should never use ice or heat when you have impaired sensation, as you will not be able to feel if the ice or heat is burning you leading to tissue damage. Ice should also not be used if you have Raynaud’s disease, hypertension, rheumatoid arthritis, history of vascular impairments, and other medical histories. Heat should not be used if you have had a recent hemorrhage, thrombophlebitis, impaired mental awareness, malignant tissue, and other medical histories. Consult with your doctor if you have any past medical issues or have had any reactions to using ice or heat in the past before applying either ice or heat.

Bottom Line

Ice and heat are two simple, easy, and cost-effective ways to manage pain outside of the clinic and between your PT appointments. Ice is generally used when the tissue is irritated and swollen. Heat is generally used when the muscle is stiff or painful for several days.

CAUTION: Both ice and heat can cause burns and tissue damage so be careful and take the ice/heat off if causing more pain, too hot, or too cold.

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