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Ice vs. Heat

November 26, 2014 0 Comments

As you step off the curb to cross the street, your ankle rolls under.  You wake up in the middle of the night with shooting back pain…for the third week in a row.  Yesterday, your neck was a little sore upon rising.  Now, you can’t even look over your right shoulder.  Should you ice?  Use heat?  Does it really matter?  It does.  Using ice and heat can be an effective and inexpensive way to manage pain but it is critical that you use them properly.

The body’s response to soft tissue damage is inflammation.  Immediately after the injury occurs, the body begins to send cells and nutrients to the area to help clean it up and being the recovery process.  There are three stages of inflammation:


  • Time Frame:  0-72 hours after injury occurred
  • Cardinal Signs: pain, swelling, heat, redness, loss of function
  • ICE


  • Time Frame:  72 hours to days or even weeks
  • Cardinal Signs: decreased pain, swelling, heat, redness and some increase in function
  • CONTRAST THERAPY: combination of ICE and HEAT


  • Time Frame:  days to one year and beyond
  • Cardinal Signs: significantly decreased pain, swelling, heat, redness  of initial injury but pain at tissue stretch
  • HEAT; ICE continues to benefit as well

Ice is mission critical in the acute and subacute phases, or the first 2-3 days, of your injury.  At this time, your body is sending help via blood and lymph to the injured area to begin the repair process.  This causes edema, or swelling.  Using heat at this time would increase the circulation leading to additional swelling, increased pain and prolonged recovery.

To use Ice properly:

  • Use a reusable cold pack, bag of frozen veggies or bag of ice.  Wrap a towel around the pack before applying to skin. You can moisten the towel for deeper penetration.
  • Apply for 15-20 minutes waiting at least 1-1.5 hours between applications.  Apply 2-3 times per day.
  • Skin will turn red but should return to normal about 20 minutes after pack is removed.


  • if skin turns red with blotchy white spots, you have excessively cooled the area and should wait longer to reapply and shorten the amount of time for the next application.
  • if you have a medical condition that affects circulation and/or have experienced frostbite to that area before, consult your physician before applying cold.

Contrast Therapy: Ice and Heat
Contrast therapy is an effective method during the Subacute and Chronic phases, or 3 days and beyond.  During the subacute phase, the body begins to shift its healing mechanisms; adding heat to your treatments can be of great benefit. The cold flushes out excess inflammation and the heat draws fresh cells and nutrients to the area via increased circulation. For this reason, you want to end the contrast therapy sessions with cold so that the area does not stay congested with excess inflammation.

To use Contrast Therapy properly:

  • Contrast Therapy may be used after the first 3 days of injury, during the subacute and chronic phases, until the injury heals.
  • Forms of cold and heat:
    • ice packs and electric or microwaveable heating pads/packs
    • 2 buckets: one filled with ice and cold water, the other with hot water (use care to avoid boiling, scalding water to prevent burns)
  • Ice Pack/Heat Pack: 1:2:1 ratio of cold to heat (example: “Cold for 5 minutes” then “Heat for 10 minutes” then “Cold for 5 minutes”)
  • Buckets, or slush immersions: Start in the cold bucket.  Stay there as long as you can tolerate (you will experience cold, burn, ache and numb; at numb you should switch), then switch to the warm bucket (you will experience tingling and then a return to normal; at normal switch back to the cold bucket).  Go back and forth until the water temperatures have evened out and/or about 20 minutes.  Finish with cold.


  • As always when applying cold or heat to the skin, be cautious not to overdo it!  Excessive cooling could lead to frostbite; excessive heating could lead to burns.
  • If you have a medical condition that affects circulation, consult your physician before using contrast therapy.

Who doesn’t love the soothing, comforting feeling of heat?  While heat is probably the preferred method for pain management, it is only appropriate in the SubAcute (in combination with ice) and Chronic phases of injury, or 3 days and beyond.  DO NOT USE HEAT WITHIN THE FIRST 72 HOURS OF INJURY!!  As mentioned earlier, additional heat in the acute phase will increase inflammation resulting in increased and/or prolonged pain.

To use Heat properly:

  • Heat is ideal for injuries in the chronic phase of inflammation.  It may be combined with ice during the SubAcute phase and should not be used at all during the Acute phase.
  • Forms of Heat:
    • Electric or microwaveable heating pad, hot shower, analgesic cream, warm compress
    • As with ice, a moist application will allow for deeper penetration
  • Apply heat for 2o minutes, waiting at least 1-1.5 hours between applications.  Apply 2-3 times per day.
  • Skin will turn red but should return to normal once the pack is removed after 20 minutes or so.


  • Heat should not be used by individuals with impaired sensations
  • If your skin remains red long after heat is removed, seek medical assistance as you may have a first degree burn
  • Too much heat can cause congestion in the area resulting in prolonged or increased pain.  With too much heat (staying on a heating pad for several hours, for example), your body triggers a reflexive response that actually causes muscles and joints to become stiff and sore
  • Use one form of heat at a time to avoid excessive heating.  If you have just taken a hot shower wait an hour or two before applying a heating pad.  If you have applied a warming analgesic cream (such as Tiger Balm), wait an hour or two before applying a heating pad.
  • If you have a medical condition that affects circulation, consult your physician before applying heat.

It is important to care for your injuries from the initial onset through to your complete recovery.  The use of ice and heat can be a great, noninvasive way to manage pain – whether it is new pain or pains that you’ve become intimately familiar with.

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