Have you tried ice or heat? This is a common question asked by physical therapists during initial evaluations of patients. Many times, the patient has tried one or the other, but was unsure which option would benefit them the most. Knowing the benefits of each modality along with knowing the proper duration for each can help patients manage injuries from the start and speed up the recovery process.

When Ice Should Be Used

  • Acute or chronic pain
  • Acute or subacute inflammation
  • Bursitis
  • Muscle spasms
  • Abnormal tone
  • Tendonitis
  • Musculoskeletal trauma
  • Myofascial trigger
  • Tenosynovitis


How Applying Ice Works for an Injury

Ice helps decrease the local temperature of the tissue, which results in decreased blood flow, edema, and muscle tone. It is also shown to slow metabolic rate and nerve conduction velocity. It can also help increase the body’s pain threshold. Ice should be applied for 20‐30 minutes at a time. You should give your tissue adequate time to return to normal temperature between icing sessions.

Some potential reasons ice might not be a great option for you include cold intolerance, cold urticaria, cryoglobulinemia, infection, over regenerating peripheral nerves, or any form of vascularization problems (such as PVD or Raynaud’s).

When Heat Should Be Used

  • Abnormal tone
  • Decreased range of motion
  • Muscle guarding
  • Muscle spasms
  • Myofascial trigger points
  • Subacute or chronic pain
  • Subacute or chronic inflammatory conditions


How Applying Heat Works for an Injury

Heat helps increase local temperature to the tissue resulting in increased blood flow to the area, increased capillary permeability, increased collagen extensibility, increased metabolic rate, increased muscle elasticity, increased nerve conduction velocity, and increased pain threshold. Hot packs should be applied for 15‐20 minutes at a time.

Possible reasons you should not use heat following an injury include acute muscle trauma, arterial disease, bleeding or hemorrhage, over cancerous area, peripheral vascular disease, or thrombophlebitis.

After looking at all the benefits of using ice and heat for injuries, here are some easy-to-remember rules to pick your proper modality.

  • If the injury is new and has occurred within the last 3 days = Ice
  • If there is noticeable swelling = Ice
  • If you have no significant swelling and decreased range of motion = Heat
  • If you have increased muscle tightness, spasms, or trouble relaxing muscles = Heat
  • If you have had pain for an extended period of time with no range of motion loss and significant
    swelling = Ice first, then Heat

If you are looking to #GetYourMoveBack, make an appointment at any of our valley-wide locations and you can see a physical therapist within 24-48 hours.

Cameron M. Physical Agents in Rehabilitation: From Research to Practice. Fourth Edition. W.B. Saunders Company. 2013.
Prentice W. Therapeutic Modalities in Rehabilitation. Fourth Edition. McGraw‐Hill Inc. 2011.

In Arizona, residents can enjoy year-round sun shine and a dry heat, also known as perfect golfing weather. During our winter months, we see a great influx of travelers escaping the snowstorms in their home states. Golfing is one of the most popular forms of exercise for this population as it helps them stay fit and active while at the same time enjoying this desert climate. With these residents migrating to Arizona, physical therapists often see more patients with golf injuries due to the physical demands on the body of hundreds of swings per round. Jack Nicklaus once said, “Professional golfers’ condition to play golf; amateur golfers play golf to condition.” This statement is the epitome of what leads golf injuries that physical therapists treat daily.

The most common golf related injuries in amateur golfers are low back, shoulder, elbow/wrist, and lower extremity related injuries. With each golf swing, the body undergoes a unique combination of compressive, shear, rotational, and lateral bending forces especially on the vertebrae.  Below are the most common injuries experienced by the average everyday golfer.

Amateur golfers tend to lack strength in the wrist that leads their club into impact with the back of the lead wrist and create overload. This overload leads to hitting the ground and flattening the wrist angle, which stresses the wrist extensors at the dorsal aspect and in turn causes tendinitis after several repetitions or swings.

Medial epicondylitis, or “golfer’s elbow,” is one of the most common elbow injuries for golfer’s, along with tennis elbow. Golfer’s elbow is an inflammation of the tendons that attach your forearm and wrist musculature to the inside of your elbow. These muscles and tendons can become damaged from overuse which is common in golf.

The rotator cuff is one of the most at-risk muscular structure at risk for injury while golfing along with labral tears. These injuries can be traced to the backswing and torque required for each swing. Golfers can tend to keep the lead arm tight against their chest as they swing causing possible tearing of the posterior labrum.

With each swing, the inside of the lead knee absorbs a tremendous amount of torque and compression. Many golfers square the lead foot and lock in the knee which internally rotates the position causing an increased shearing force on the knee joint. This stress can cause meniscal tears and an increase in arthritis within the joint.

Lower Back
A strained lower back is the most common golf injury and is most likely to end a patient’s golf career. Many golfer’s attempt to produce power through their swing by rotating the pelvis through each swing. This creates torque between the pelvis and the lumbar spine. With each swing, this pulls on the ligaments, tendons, and muscles of the lumbar spine. The shearing forces on the spine can cause intervertebral discs to degenerate quicker and reduce the space and lead to degenerative disc disease.

These injuries are common among golfers, but as physical therapists we can provide the tools to rehab patients and provide the proper techniques and training to prevent future injuries on the golf course. As physical therapists, we are trained to detect any abnormalities in functional mechanics of gait and daily activities, and the same techniques can be applied to analyzing golf swing mechanics. By analyzing a patient’s swing, physical therapists can pin point causes of pain and weaknesses throughout their swinging motion.  If you have been experiencing any pain while golfing or have any nagging injuries, Foothills Sports Medicine can help with your pain management.

Find a Foothills Sports Medicine & Physical Therapy clinic near you, and our physical therapists will evaluate your symptoms and analyze your swing to determine the appropriate treatment plan to get your back on the golf course pain free!