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Ice Verses Heat Which Is Best?

Ice Verses Heat Which Is Best?
Ice Verses Heat Which Is Best?

When To Ice And When To Heat

There is quite a bit of public confusion about the use of ice verses heat when treating injuries and managing pain. I frequently have patients tell me they didn’t ice something or heat something because they weren’t sure which one to use and didn’t want to make it worse so did nothing just to be safe. It’s a shame because using ice and heat therapy can be quite an effective and safe therapy when used correctly.

Using Ice Verses Heat

A basic rule to go by is to consider using “ice for injuries” and to “heat pains”. It is obviously more complicated than this but this is a simple reference point to go from.
The majority of ice therapy is for calming down damaged superficial tissues that are inflamed, red, hot and swollen. Hence ice for injuries! The inflammatory process associated with injury to a tissue is a healthy, normal and natural process however the inflammatory process is also incredibly painful and has a tendency to be either more extreme or persistent than required. Using ice is pretty much a mild way of dulling the pain of inflammation without the use of medications and combined with the other elements of RICE can work very well in acute injury to reduce inflammation, pain and swelling whilst increasing mobility and function of the injured tissue.

  • Examples Of When Ice Is Best: Following an acute ankle or knee sprain, a freshly pulled muscle or corked thigh or a running injury like ITB frictional syndrome

Tip: A general rule of thumb is to ice an injury over a period of at least 24 to 72 hours. During this time applying cold packs for periods of 15 – 20 minutes every two to four hours.

Using Heat Over Ice

Heat is best used for application to muscle spasm, chronic pain, and stress. Heat can work effectively in taking the edge off the pain associated with muscle spasms and trigger points, or back and neck pain conditions that are dominated by the presence of spasm or trigger points.

Tip: When using heat for back and neck pain I tend to suggest applying heat for 15 – 20 minutes at a time. And the use of moist heat (such as hot packs, baths, showers) works better than dry heat.

When Not To Use Heat And When Not To Use Ice

Heat can make inflammation worse, and ice can make muscle tension and muscle spasms worse, so this means the use of heat and ice has the potential to do harm when you get the use of them wrong.

  • The use of heat on an acutely swollen ankle will create more swelling and more pain and most likely prolong recovery from the injury as a result. The use of heat on any tissue that is inflamed and the process of adding heat to a fresh injury will almost certainly make it worse and potentially increase recovery times.
  • The use of ice in the wrong situation has less dramatic effect than that of using heat when you shouldn’t. Using ice on muscle spasms and trigger points present with neck pain and back pain will most likely cause the muscles in spasm to contract harder and trigger points to ache more making someone temporarily feel worse but is unlikely to impact overall recovery.

My advice typically for back and neck pain is to go with what ever feels best for you at the time, if it is a more chronic condition then 9 times out of 10 heat applied from something such as a wheat bag will feel better however with more acute pains in the neck and back ice may sometimes prove helpful particularly if superficial inflammation is involved.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Ice Verses Heat Which Is Best? should consult his or her general practitioner, physiotherapist or otherwise appropriately skilled practitioner.

Hayden Latimer is the founder of and principle physiotherapist at Sydney Physio Clinic. Since graduating from Otago University, Dunedin, New Zealand he’s gained wide experience practicing across the globe for over 15 years and is now extremely knowledgeable in helping people reduce discomfort and restore function and mobility.


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