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Sports Performance | Physical Therapy

Ice or Heat? How to Choose One, Both, or Neither

February 9th, 2022 | 4 min. read

Ice or Heat? How to Choose One, Both, or Neither
Jon Delk

Jon Delk

Chief Operating Officer // Partner // Licensed Physical Therapist, PT, MSPT // EW Motion Therapy

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We all fell when we were kids. Running on the playground, riding a scooter or bike, or even just walking across a flat surface, every kid has a fall where they scrape a knee or elbow and sometimes are a little sore afterward. When I had scrapes as a kid, my mom would sometimes give me an ice pack to hold onto the area so it wouldn’t be so sore. However, not every incident or ailment is that simple. Usually, ice or heat can help anything feel better, but not if you choose the wrong one. So when should you select ice, and when should you choose heat? 


At EW Motion Therapy, we often use ice and heat as part of our treatment, whether in physical therapy or a wellness program. Our therapists are trained on applying them so that you get the best treatment for you every time. Even if you do not choose to seek treatment with us, we still want to advise whether ice or heat is the best solution for whatever pain or other ailments you are experiencing.   


This article discusses the use of ice and heat, when it can be beneficial to use both of them, and when to avoid both. With this information, you can better assess your condition and make the best choice to help you feel better. 


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When should I use ice? 

Also called cryotherapy, icing can be beneficial for acute inflammation right after a trauma. For example, when you sprain your ankle, you should reach for the ice pack, because ice is a temporary numbing agent and can help with immediate pain relief. The cold controls inflammation and constricts blood vessels, which decreases swelling (edema). Too much swelling can create additional problems that you should try to avoid. You can also use ice after a strenuous activity - this is why so many athletes take ice baths. Just remember that when you ice a concentrated area with an ice pack, always have a thin layer of clothing or a towel between your skin and the ice pack - you could get frostbite otherwise.


As far as ice application, gel packs are great because they can be molded to fit an area and provide the best coverage. You can buy gel packs over the counter, or make them at home using a large Ziploc bag and a mixture of water and rubbing alcohol. You can also freeze a Dixie cup full of water and rip off the top half to give yourself an ice massage for 2-3 minutes. This is great for small areas and bony prominences. 


When should I use heat? 

Using heat is also called thermotherapy, and as we know, it has the opposite effect of ice. It brings nutrients and oxygen to tissue and increases blood flow. This is why you tend to reach for a heating pad when you have tense muscles - the heat can be great for tension relief. Any kind of chronic pain and tension can benefit from heat, and you can sometimes use heat before activity to loosen up.


The primary precaution with using any kind of heat is to prevent burns. Always have a layer between your skin and the heat source that is thick enough to guard against burns. Always have the heat source with its insulation resting freely on the skin’s surface without additional body weight pressing the heat against the skin. For example, never lay or sit on a hot pack.  


Hydroculator packs tend to be more effective - these are heat packs with a clay substance that go into a thick towel. A hydroculator is often used in physical therapy, which are tanks designed to heat water to a specific temperature. Hydroculator packs are stored in the hydroculator so they can be taken out and used at the desired temperature and be additionally insulated when needed. Again, always have a barrier between your skin and the heated element to insulate against burns. 


What about both, or neither? 

So when should you use both ice and heat? When treating an injury or healing after surgery, generally you should use ice in the early stages and heat in the later stages of healing. Contrast therapy, which is alternating heat and ice for a specific amount of time each, can be very beneficial to reduce inflammation and generally improve circulation. Still, every contrast session should end with ice. 


You should avoid both ice and heat if you have certain medical conditions or nerve damage that make you sensitive or unable to sense extreme cold or heat. Also, wait for any open wounds to heal before putting ice or heat on them. Each body responds differently to different treatments, so always exercise caution when you apply either. 


What makes them more effective? 

Now you know more about the benefits of ice and heat, and how you can use them. For any injury, ice or heat should not be the only treatment you pursue. They can be great for immediate relief, but both are much more effective when used in conjunction with other therapy modalities. 


Our clinicians at EW Motion Therapy take advantage of the benefits of ice and heat to help our patients feel better. If you are interested in pursuing therapy with us, fill out the Request an Appointment form on our website, and someone from our staff will contact you within 48 hours with your next steps. 


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