Heat vs Ice?

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In the PT clinic, we use heat and ice every day, and people ask me all the time whether heat is better or whether they should use ice to decrease pain and speed up healing….
There seems to be a lot of confusion on the topic!
In this post I aim to clear up the confusion, so you can know which to use and how to do it most effectively. You’ll know what heat and ice actually do to the body, when to use heat and when to use ice, what types of heat and cold materials are best to use and precautions against their use. And your friends and family will think you’re a medical genius, now that you’ve mastered this topic that is so rife with confusion!
So, most of our clients at Active PT are age 40+, and folks in this group tend to get stiff and don’t like the cold as much, hence they automatically gravitate toward using heat, because it feels warm and cozy. Although that does indeed sound like a very scientific rationale for sticking with heat, there are a few more variables to consider!
So here’s the low down on Ice vs Heat.
Spoiler summary (for those who love ‘cliff notes’ instead of the whole book):
My overall summary of ice vs heat is that if I had to choose just one modality in the clinic: heat, ice, ultrasound, E-stim… I’d choose ice. All by itself it decreases inflammation, the cause of most pain we see in the clinic… and it has no downside to it! You’re never going to hurt yourself by putting ice on something (common sense alert: see precautions below). Yes, it feels cold and not as cuddly as heat, but that’s not the point- we’re talking effectiveness here. Heat, by contrast, can actually worsen your situation: if you have joint swelling and inflammation and you heat it for > 15 minutes and don’t move it afterwards and it stays stagnant, you can actually bring more swelling and inflammation to the area, worsening the condition. But read on for when heat is the better choice, it can still be good too.


Effect on the body
Ice is an anti-inflammatory, anti-“flame”, so it fights heat. Ice constricts blood vessels and squishes out fluid as a result, shrinking swollen tissue and making swollen, hot joints less painful and easier to move. That’s the main reason ice makes things feel better if it’s used at the right time- it decreases inflammation. And yes, It also can have a numbing effect, but the real reason it makes  people feel better is it decreases inflammation.
When to use ice
  • Acute injury: Ice is for any time you just did something to your body that has the feeling of a potential injury (sharp pain, throbbing pain, burning, constant pain, etc)- it just feels wrong or like it might be injured. If you just did it and it hurts, put ice on it. It’s perfect for right after an injury.  Let’s also clear this one up: the whole thing about ice for 3 days then heat is nonsense: if you have pain and inflammation, use ice. Period. After an injury, inflammation doesn’t go away after 3 days. Keep using ice until the pain and swelling goes away- this can be for weeks and even months.
  • Inflammation: feelings of heat, tightness and especially swelling: use ice to shrink it down. If Ibuprofen works for you, you likely have inflammation (because Ibuprofen is an anti-inflammatory), so ice will probably help you.
  • After exercise: we use ice at the END of many of our treatments in the clinic. It calms potential inflammation or irritation down from the activity (or manual therapy, or assessment)- do it at the END, not the beginning.
  • Prevention: Ice is great at preventing injury. So if you just did some activity or movement that you think might bother you the next day, even if you didn’t actually injure it, you just overdid it a bit- use ice right away.  It can help PREVENT an injury.
DON’T use ice if it feels worse AFTERWARDS. It’s normal to feel some stinging and mild discomfort from ice DURING the ice, but it should “numb out” and feel better after about 5-10 minutes into the ice treatment. But in some types of nerve pain, like carpal tunnel or thoracic outlet syndrome, the nerves in the area of pain are just too sensitive, and ice will increase achiness and pain sensation during and AFTER the ice.
Types of “ice” to use
In the clinic and at my house, we use gel packs put in a freezer (*see below), that mold to the skin, so there are no air-pockets- it makes it more effective. We put them in a pillowcase for insulation. But you can use a bag of ice (insulate it with a dish towel), or even frozen peas or corn. There is even a cool (pun intended) home ice pack recipe you can make at home: 2 cups of water, 1 cup of rubbing alcohol: pour into a gallon freezer bag, and freeze x 4 hours. It will freeze into a slush/gel. What you DON’T want: one of those hard, square packs that doesn’t mold to the skin, those belong in an ice chest.
*You can find the cold packs we use HERE
How long to use Ice
Keep the ice on for 15 min, any longer and you can burn your skin (feels like a rug burn, won’t kill you but I don’t recommend it) – especially if you’re using an actual bag of ice. In general, put it where it hurts. Gel packs lose their cold effect after 15-20 min, and you can keep them on a little longer if you want. As a treatment for injury, do it 3-5 times/day (you can do it every hour if you LOVE it). If you know you should ice, a good way to fit it into your busy day is to do it once in the AM before you get going for the day, once when you return home in the PM and a third time right before bed. As a prevention of injury (if you’re not actually injured, just trying to prevent increased soreness), do it 1 or 2 times right after the potentially irritating activity.


Effect on the body
Heat increases the temperature of the superficial tissue. The body reacts to this by “vasodilation”, which means it opens up the diameter of the blood vessels, bringing more blood to the area. This is good if there is, what the eastern healers would call “stagnancy” – lack of blood flow, lack of movement of the tissues and associated blood and fluid. This is the case with morning stiffness- when we wake up feeling cold and stiff and creaky. When we put heat on an area that’s not moving easily, the increased movement of tissue fluid and blood feels good and gets things moving again.
When to use heat
  • Stiffness: when you feel limited in your range of motion, your ability to move freely – lack of fluid movement – times when you know it would feel good to get “loosened up.” We will even use heat for a short period, about 10-15 minutes, on post-surgical conditions, like rotator cuff repair or total joint replacement surgery, to loosen up the joint BEFORE we move the area around. We’ll warm it up, move it gently or exercise it, then put ice on afterwards.
  • Before activity: you’re already familiar with this sequence: “warm up… cool down.” Put heat on the involved area BEFORE you exercise, pull weeds in the garden or do your stretches, to “warm up.” Then do the activity. If needed, you can “cool down” with the ice at the END.  To me, the key with heat is to move the area after the heat: just marinading on it doesn’t help- you’ve got to move or stretch or exercise afterwards to reap the benefit from the heat.
DON’T use heat if it hurts worse during or AFTER the heat. If a joint or area is really swollen and irritated, the heat can pull more fluid to the area, making it more swollen and feel worse AFTERWARDS- don’t use heat in this case- ice will be the one to use.
How long use heat
Apply the heat for 15 minutes. Put it where it feels stiff. You can lay on top of it or have it on top of you- just know it will be more intense if you lay on top of it, and turn the temperature down accordingly- you should NEVER feel discomfort, just comfy warm. Longer than 15 min on the heat, and you could increase swelling if there’s an unidentified injury underneath.

Types of “heat” to use

We generally use heating pads here in the office- the slightly fancy plug-in type (*see below- I am not affiliated with them in any way, FYI). These ones are nice because you can set the temperature to your liking and have a timer for shut off. Another obvious form of heat is a hot bath or shower. Hot tubs also count as heat. For hands, we use a paraffin bath, the same type found in day spas and nail salons. There are other fancy types of heat, like laser, ultrasound and infrared devices, but I’ll skip those since they’re not really what we’re talking about here.
*You can find the heating pad we use HERE


Don’t use cold or heat packs:
• if it hurts worse AFTER you use the heat or ice
• over areas of skin that are in poor condition
• over areas of skin with poor sensation to heat or cold
• over areas of the body with known poor circulation
• in the presence of infection


In summary, use heat to “warm up” an area before activity and ice to “cool down” the region after the activity. If you’re injured, use ice. If you’re just stiff, use heat. Don’t use either one if they feel worse AFTERWARDS.
Bam! Thats it! Now go show off your new knowledge to your body 😃 …
I hope that cleared it up and you feel confident now in how to choose between heat and ice!
If you have questions regarding the proper treatment of an injury, or want to make sure whether YOUR situation would be better for heat or ice, send us a message HERE or give us a call  at (805) 934-0663. We’re happy to listen to your situation and help you make the best decision for what is going on with YOU.
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