Heat or Ice?

Should I apply heat or ice?

A majority of patients who come into the clinic, weather from a sporting injury or episode of back pain, will ask us- should I put on heat or ice?

Effects of heat and ice

By putting on a heat pack it causes local heating of tissues relaxing the muscles in the area. This causes an increase in blood flow, metabolic rates and cell proliferation while decreasing muscle tone, spasms and pain.

The use of ice or cold sprays causes vasoconstriction and reduced blood flow to area to stop potential swelling. This response decreases metabolic rate, pain and neural activity and slows the inflammation response.

So what should you use?

From this we can see that heat or ice has very different effects that can help in different stages of healing or injury.

As a general rule, ice should be used for acute injuries for an example a sprain or strain or inflammation conditions such as acute tendonitis such as in tennis elbow, runners knee or Achilles tendonitis. By application of ice, inflammation in the area is reduced and swelling can decrease. Heat on the other hand is useful in more chronic conditions or sore muscles. Heat can help relax sore, stiff and achy muscles.


When should you not use.

If you have any of the following or suspect any of the following conditions, it is advised to not use heat or ice therapy:

  • DVT or active bleeding
  • Over reproductive organs
  • Damaged skin
  • Local infections or reduced sensation
  • Over metal (jewellery or implants)
  • Over burns
  • Open wounds

  • Sensitive tissues including eyes, anterior neck or area of pregnancy
  • Burns/ Frostbite
  • Heat should not be used over a bruised muscle for up to 3 days

How to use?

When using a cold pack/ bag of frozen vegetables, wrap it first in a moist towel, and place it on the area of injury for up to 20 minutes every 1-2 hours. If you are trying to apply cold to the hand or foot, this may be more challenging to keep the cold pack in place. Therefore, to effectively apply cold in the area a cold bath made from a bucket of cold/ ice water that is tolerable can be used for 15-20 minutes every 1-2 hours.

A dry towel or cover should be used to cover a hot pack when using heat to help protect the skin. Hot packs can be used for 15-20 minutes every 1-2 hours as needed. However, any form of heat can help to relax muscles, therefore a hot bath can help an achy back.

It is important to remember that these recommendations are guidelines. If there is any increase in pain, the symptoms are worsening, or any concern then the heat or ice should be removed.

Are there any risks?

Like with any treatment there are minor risks including burns with heat packs and frostbite or numbing with ice packs. To minimize these risks:

  • Have a towel / cover over the pack
  • Never lye on top of the heat or ice pack
  • Never leave the heat/ ice pack on more then recommended
  • Regularly check the skin
  • If there is any increase in pain or symptoms remove

If you have any questions regarding heat or ice, or questions regarding your injury, call a physiotherapist today at 045-853726   or book online at https://physiotherapyworks.ie/book-online/

By Tara  Moore MISCP

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