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Heat or Ice – Is one better than the other?

7/28/17 7:06 AM

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A very common question that patients ask during their physical therapy treatment is whether they should use heat or ice for pain relief.  The main consideration before deciding which to use, is determining whether or not inflammation is present in the painful area.


What is inflammation?

Inflammation is defined as “a localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection.”


Inflammation is usually present within the first week after injury. However, inflammation can become a chronic problem if the injury is taking longer than normal to heal, or with chronic inflammatory conditions such as arthritis. 


How to determine if inflammation is present

When you examine the painful area, ask yourself these questions:

  • Was this a traumatic injury? (Was there an accident or event that led to your injury?)
  • Did the injury happen less than a week ago? 
  • Is the area swollen?
  • Is the area red or warm to the touch?

If you answered yes to any of these questions, inflammation is likely present.


Ice reduces inflammation and decreases pain.

Applying ice over an injured area causes the blood vessels in the area to constrict, limiting blood flow to the area.  This helps reduce inflammation and swelling.  Ice also slows down the nerve signals carrying pain information from the injured area, resulting in pain relief.


If inflammation is present, applying ice to the area may help decrease inflammation/swelling, and will reduce pain. 


*Consult your physical therapist prior to using ice if you have any of the following: Raynaud’s disease, rheumatoid arthritis, circulation problems such as PAD/PVD, or over active wounds.


How to use Ice


Cold pack: Wrap cold pack in a thin cloth (a pillowcase works well).  Apply directly to inflamed/injured area, and apply pressure for 15-20 minutes, up to 3 times per day.  You can use an elastic wrap to hold the ice in place.


Bag of frozen peas: If you don’t have an ice pack, a bag of frozen peas also works well, conforming well to various body areas. Simply follow the same instructions above.


Heat relaxes muscles, increases blood flow, and reduces pain.

If you are experiencing muscle tightness, spasms, chronic pain, joint stiffness, or tender points in your muscles, and do not show any of the signs of inflammation above, heat may be an appropriate treatment for you.  Hot packs or heating pads can be used to relax tight muscles, decrease pain, and improve blood flow to promote healing.  Heat can also be used to increase the extensibility of muscles prior to stretching. 


*Consult with your physical therapist prior to applying heat if: you observe signs of inflammation, you have a bleeding disorder, decreased sensation (numbness) in the area, open wounds, systemic lupus, or you are pregnant.


How to use heat


Electric heating pad – Make skin is dry and intact without any open wounds, apply to painful area, and adjust settings until you feel gentle warming sensation.  Check the skin under the pad every 5 minutes to avoid burning skin.


Microwaveable hot pack – Make sure skin is dry and intact, follow manufacturer’s instructions, making sure to apply enough toweling around hot pack to avoid burns. Examine the skin under the hot pack every 5 minutes to avoid burning skin.


These are general guidelines for the use of heat/ice for minor injuries.  These guidelines are subject to change if you have additional health problems, or if you are recovering from surgery.  If you are unsure whether to apply heat or ice, it is best to contact a physical therapist or other healthcare professional for further guidance.


Have any other questions?  Please reach out to our physical therapists and we will be sure to get back to you!


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There are other treatments that help provide relief to you pain as well.  Remember those Olympians with the red spots on their bodies?  Check our our cupping video to see if that may help you as well!

Written by Lauris Rigdon, PT.

Topics: pain