Ice Verses Heat Which Is Best?

When To Ice Verses When To Heat

Generally there is still some confusion around the use of ice verses heat when treating injuries and managing pain. Frequently I will have patients tell me they didn’t ice and injury or heat some pain because they weren’t sure which one to use and didn’t want to make it worse, so they did nothing “just to be safe”. It’s a shame because using ice and heat therapy can be quite an effective and safe therapy for managing pain when used appropriately.

A Simple Rule Of Thumb

A simple rule to go by is, use “ice for injuries” and “heat for pains”. It is obviously more complicated than this, however applying this as a simple rule of thumb you will seldom go wrong. Typically ice therapy as a treatment modality is recommended as appropriate approach when looking to calm down damaged superficial tissues, 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 can also incredibly painful and has a tendency to be either more extreme, or persistent than actually necessary to get the repair process underway.  Using ice is pretty much a mild way of dulling the pain of inflammation without the use of any medications, combined with the other elements of the R.I.C.E first aid approach ice can work very well in many acute injuries to reduce inflammation, pain and swelling, whilst increasing mobility and function of the injured tissue.

• An Example Of When Ice Is Best: Following an acute ankle, or knee sprain, freshly pulled muscle, corked thigh, or a running injury such as ITB frictional syndrome… These acute sprains and strains can all benefit for short term use of ice to assist in the management of swelling and pain.

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 at 2-4 hour intervals.

Using Heat Over Ice

Heat is best utilized for the application to muscle spasm, chronic pain, and stress. Topical heat can work really effectively in taking the edge off pain associated with muscle spasms and trigger points. Back and neck pain conditions dominated by the presence of spasm or trigger points will frequently respond really nicely to heat and gentle movement in my experience. The use of moist heat such as moist hot packs, baths, showers, works better as a pain management approach than dry heat. Tip: When using heat for back and neck pain I would suggest applying heat for around 15 – 20 minutes at a time. Mild to moderate heat is enough, there is generally no need for any applied heat to register as “hot”. It is important to be aware that a desire to eliminate pain can lead to people applying heat at a level beyond what the tissues can withstand and end up giving themself a burn. With both heat and ice therapy I have regularly had patients attend the practice following having applied heat or cold treatment for either too long, or at greater temperature extremes subsequently giving themselves an ice, or heat burn. The use of mild cold and heat is safer and I strongly suggest avoiding anything other than this, unless applied by a medical professional. 

When Not To Use Heat Or Ice

Heat has the potential to increase inflammation, swelling and bleeding and ice may exaggerate any muscle tension and muscle spasms. Meaning the use of heat and ice as therapies have the potential to do harm when used incorrectly or with inappropriate timing.

• The use of heat on an acutely swollen ankle may create more swelling and more pain, this as a result may end up prolonging recovery times from injury. Heat on any tissue that is inflamed by 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 in my experience has a less dramatic and less detrimental effect than that of using heat when you ideally shouldn’t be applying any warmth to a tissue. Using ice on an area with muscle spasms and “active” trigger points as frequently presents with neck pain and back pain can cause the muscles in spasm to contract harder and any trigger points to “ache” more. This subsequently may make the individual feel temporarily worse but is unlikely to impact their overall recovery. This is not a hard and fast rule, as some patients I find still feel relief following the application of ice to areas of spasm, as in acute back pain, most likely due to the harnessing the analgesic properties of ice.

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 sometimes patients may find that ice proves helpful, particularly if any 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.