Heat Or Ice?

One of the most frequent questions I get asked by my patients regarding their pain is, “Should I use heat or ice?” Before I answer, let me tell you a brief story.

Back when I was in PT school, whenever someone had a question for the professor, we discovered that there was always a pretty good chance the answer would be, “It depends.” You can imagine how frustrating this was. Here we are, spending countless hours and thousands of dollars to learn how to practice our trade, and the answer to my questions is “it depends?” I, and many of my classmates, came to despise this phrase.

After practicing physical therapy for a while now, I have learned to accept that often times the answer really is, “it depends,” but I still don’t like it. The reason this is the answer to many things in the field is that there are always variables that can impact the answer. The answer to any given question in this field is often times very situational. More information is typically needed to provide a specific answer. Variables may include: What is the patient’s age? Where is the pain? How long has this been going on? etc. While the reason behind the rote response is understood, it was often extremely frustrating, and at times bordered infuriating, as a student.

So getting back to the initial question here, and the reason for this post, “Should I use heat or ice?” Well… believe me when I say I feel your frustration, but “it depends.”

Don’t worry, I won’t leave you with that. I will try to give you a little more guidance…

The biggest determining factor is whether or not you have active swelling from an injury. If you do, then typically using a cold pack for 15-20minutes on and 15-20 minutes off is recommended. Leaving ice on for longer than that (or after your skin becomes numb) can lead to burns or even increase swelling. So when using ice/cold packs, make sure to take it off for about 15 minutes before reapplying. Ice is great for decreasing pain and helping to control swelling when used properly. If you put heat on an area that is swelling, let’s say a sprained ankle, you can increase the swelling leading to increased pain. Note: If you have an impaired vascular system, decreased sensation, or poor circulation (i.e. Reynaud’s disease) you should avoid using an ice pack, or at least speak to a medical professional first.

On the flip side… If you have general muscle soreness or stiffness, and no swelling, placing a hot pack on those sore muscles can often feel pretty good. Just make sure not to fall asleep with it on or place a hot pack on top of an area you just recently put muscle cream on as this can also lead to burns. It’s generally pretty safe to put a hot pack on for about 20 minutes or so as well. Note: If you have decreased sensation, you should also be careful with using a hot pack as you could cause a burn before you realize it is too hot.

If you do not have active swelling (say your injury occurred a month ago) and you are still sore, stiff, or have some pain you can use either hot or cold packs.

If you’re just not sure, and your aches, pains, or stiffness aren’t getting any better, you can always contact a physical therapist, because the answer to “Should I use heat or ice??” really is, “It depends.”

I hope this helps. If you have questions or you would like to learn more about how we can help you reduce your pain give us a call at 208-557-1470 or book a Discovery Visit with us to spend 15-20 minutes one on one with a physical therapist to discuss your pain, and learn what your options are.


Dr. Tyler Burke

DPT, Owner and Founder of Switchback Direct PT

We help injured outdoor enthusiasts to stop hurting and start adventuring.

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