Ice or Heat?

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.

Wade Weisnicht

PT, DPT | South Chandler