How to know when to ICE vs. HEAT an injury

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When to ice or heat an injury

Sometimes it can be difficult to determine when to heat or ice an injury.  Both modalities have the ability to reduce your pain but sometimes either can also exacerbate your symptoms.

As a rule, I prefer to choose heat over ice when there are no contraindications or when it doesn’t create any adverse effects.

Ice will reduce inflammation but this is a normal part of the healing process and is really only a problem when it’s persistent or in excess.

Both these modalities are commonly used to manage musculoskeletal injuries including:

  • Lower back pain
  • Neck Pain
  • Rotator Cuff Tendinitis
  • Tennis Elbow (Lateral Epicondylalgia)
  • Knee Ligament Injures (ACL, PCL, MCL, LCL)
  • and so much more…

Follow these guidelines to help you decide if you should be using ice or heat to treat your injury at home:

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Use ICE if:

  • there is an abundance of inflammation or swelling that needs to be reduced
  • the affected area is red, hot, and swollen
  • the injury started recently (less than a week or two)
  • there is a pulsating or throbbing associated with the pain
  • anti-inflammatory drugs such as Advil improves your pain
  • you are sore after exercising and prefer ice over heat
  • you do not typically have any adverse effects by using ice (example: worse pain)

Use HEAT if you:

  • need to loosen up tight muscles and stiff joints
  • are about to perform stretching exercises
  • are looking to increase blood flow to encourage healing
  • have a dull ache
  • are beyond the acute phase of injury (after 7-14 days)
  • are sore after exercising and prefer heat over ice (see my post on overdoing it with rehab exercises) How do I know if I’m overdoing it with my rehab exercises?
  • do not typically have any adverse effects by using heat (example: worse pain)

Clinical Application

In my practice, I try to move from ice to heat as quickly as possible with clinical justification and keeping my patients as comfortable as possible. I encourage active pain free motion as much as possible in the early (acute) phase, which can also help clear excessive inflammation quicker.

I normally limit icing to 10-15 minutes per area and heating to 20-30 minutes, and don’t repeat until after the tissue has returned to it’s baseline temperature.

Mediums

There are an abundance of ways to generate heat or cold (ice) for application on an injury.  Most commonly ice and heat packs, placed in the freezer or microwave, are used for home use.  However, other options include:

  • Digital heating pads
  • Contrast Bath (Hot and Cold)
  • Paraffin wax
  • Continuous Therapeutic Ultrasound
  • Ice Massage
  • Cryocuff
  • and more

Conclusion

If neither ice or heat have any effect on your symptoms, consult with your medical practitioner for additional options you can use at home. (example medication, therapeutic positioning, therapeutic taping, activity modification, exercises, etc.)

Feel free to reach out with any questions – Ask a Physio.

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17 comments

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