Hot or Cold?

Have you have ever strained your back, tweaked your neck or sprained your ankle? The question arises: “Should I use heat or ice? “

Ice will reduce pain and inflammation immediately after your injury, or after any re-injury that causes a flare of pain and swelling. Ice can act as a local analgesic causing a numbing sensation that decreases muscle guarding. It causes an increase in circulation, which assists in decreasing inflammation.


Ice is usually more effective than heat early after an injury and it can be of benefit for many weeks for tendonitis injuries. It is often best paired with compression (ace wrap) and elevation.

Ice treatment will produce the following sensations: cold, then burning, then numbness. You must ice until you get the numb feeling but you should limit the use of ice to 20 minutes. ALWAYS use a thin cloth between your skin and the ice pack to avoid a frostbite injury. Allow 2 hours between applications. Be sure to check your skin (look for redness) before and after the application of cold. Please avoid using ice if you have impaired circulation, impaired sensation or are hypersensitive to cold.

Heat is of benefit for increasing circulation prior to exercise to minimize stiffness and improve flexibility. It can be very helpful for relaxing tight muscles, relief of pain and soreness especially prior to exercise. After an injury generally do not use heat in the first 48 hours- use ice. If you have a lot of swelling and pain, don’t use heat.

The desirable reactions take place in the first 20 to 30 minutes of heat application. Prolonged heat past this point may be harmful. DO NOT fall asleep on a heating pad. It is ideal to allow 2 hours between applications and check your skin before and after the application of heat. Don’t apply heat if your skin is broken, blistered or a rash is present.

These are general guidelines for when to choose ice vs. heat. For your particular injury or situation consult with your physical therapist for individualized advice. The physical therapists at Connect PT will team with you to determine the best treatment options to get you on the road to recovery!

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