Answered: How Do I Know When to Use Heat and When to Use Ice?

Danelle, I always wanted to know – how do I know when to use heat and when to use ice?”

So this topic I’ve visited many times in incidents with patients, and by the request of one of my current ones, I’ve decided to give you the answers to the burning questions.

When Do I Use Ice, and When Do I Use Heat?

When it comes to joints, especially small ones (hands, feet, digits), a small amount of swelling can mean the difference between full motion and no motion. So by manipulating the body’s natural response to temperature (vasodilation and vasoconstriction ) we can reduce the effects of the inflammatory response, while allowing the body to heal itself, and maintain as much function as possible.

For this to make sense, let’s take a quick look at the inflammatory process of the body. This is characterized by Dolor (pain), Rubor (redness – relative to skin tone of course), Calor (heat), Tumor (swelling) and Functio Leasa (Loss of Function). If you have these symptoms present, you have inflammation going on.

Initially there is inflammation: with an acute injury (sometimes infection), blood flow increases to the site of injury. Differing white blood cells flood to the area to fight foreign bodies (eg. bacteria) and initiate the healing process. Red blood cells also rush in if there is active bleeding along with platelets and clotting factors to stop blood loss.

In the second stage Repair, there is increased fibroblast formation to increase connective tissue strength and formation of adhesions. At this point you are about 5 days after your initial injury and a lot of the immediate pain is gone. This stage can last up to 4-6 weeks.

In the last stage Remodelling: this is where the repaired tissue starts being used in the correct way to regain function. So, for example, if you’ve sprained your ankle, you start getting back to doing the things that were difficult – walking, running. Most or all of the acute symptoms are gone at this point.

Quick medical term check –

Vasoconstriction – when blood vessels constrict or get smaller in an effort to stop heat loss.

Vasodilation – when blood vessels dilate or get bigger in an effort to increase heat loss

First things first, everyone’s response is individual!!! Most people just want a hard and fast answer – if that is want you’re looking for, then you won’t find it here. Always be sure to pay attention to how your body reacts. Everyone’s reaction may be different – as always if you experience pain or unusual symptoms, stop and consult your physical therapist.

Below there is some guidelines with explanations. In most situations, there will be a guideline, and there will always be a caveat. Can’t make it too easy now, that would be boring! 🙂 This situation is no different. The idea behind using ice and heat comes from understanding the body’s inflammatory process, and using that knowledge to enhance the good features and to diminish the bad ones.

Guideline: Ice to help with swelling/inflammation

Explanation: When you have an acute injury, inflammation is the body’s natural response to it. So to combat the negative effects of the swelling on pain, joint mobility and muscle activation, ice is recommended to decrease the local swelling at the injury side and adjacent areas.

Guideline: Heat to help with stiffness

Explanation: When there is stiffness in a muscle or joint, using heat to help increase blood flow to the area can help alleviate the stiffness. So with an injury where you feel stiff, heat is a good option to relieve the pain of stiffness and increase your flexibility

Guideline – Ice on an acute injury

If an injury is new, for example you just sprain your ankle, Ice to help decrease the amount of swelling is definitely advisable. Ice is the way to go.

Caveat: Spinal injuries sometimes get worse with ice and do better with heat. A rationale may be that the muscles needed for spinal stability don’t initially respond to ice. Some people respond negatively to ice, This may be doe to some people interpreting cold as pain (which it can be) and having a pain response. So doing a cool vs cold compress may be better, or not at all.

Still not sure which one fits your situation? Here’s a quick cheat sheet!:)

Ask yourself these questions:

Is my injury recent or an old injury?

Recent – ice

Old – heat

Is my problem swelling or stiffness?

Swelling – ice

Stiffness – heat

If you still having trouble deciding which is best for you, let’s talk so I can help you better. Some caveats are not that clearcut. Click here to book a phone consult to see which way works best for your condition.

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Danelle Dickson PT, DPT, OCS

Danelle Dickson PT, DPT, OCS

Physical Therapist at Performance Plus Physical Therapy
Danelle Dickson received her Bachelor’s Degree in Biology from Morgan State University in 2003, then her Doctorate Degree in Physical Therapy from the University of Delaware in 2007. After graduating, she earned her  Board Certified Orthopedic Clinical Specialist Certification in 2012. She is continually increasing her knowledge base with post graduate continuing education from manual based courses such as Institute of Physical Arts and St. Augustine courses. Additionally, she has also presented research at local (APTA) and international (IADMS) conferences on dancers, and has published her research with Journal of Dance Medicine and Science.

Danelle combines her 10+ year of clinical, research, and administrative experience  to produce a well rounded, patient driven experience at Performance Plus Physical Therapy. She currently works with patients with orthopedic, sports and Performing arts conditions, along with taking care of the local dance population, and mentoring local physical therapy students as a clinical instructor.
Danelle Dickson PT, DPT, OCS

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