Ice or Heat – which one and when?

Probably the most frequently asked question I get in my private practice is the question regarding whether to apply heat or ice to an area of pain.

Strangely enough, it is not as straight forward an answer as you would think and often it is upon assessment of the injury, the location and the type of pain pattern, that would determine a more accurate prescription of ice or heat.

There are however, some basic guidelines that you can follow – so that you don’t cause an injury to worsen.

Generally , if it is an acute injury ( within 48 hours of being injured) you apply ice. Ice is used to help stop swelling and bruising as it slows down blood going to the injury site, so it lessens the swelling caused by the injury. Ice can also reduce pain and muscle spasm at the injured site as it slows down nerve conduction.

Heat is generally used to treat muscle stiffness as it helps to send blood to an area and allows muscles to become more malleable and easier to stretch and contract. It is never used in the first 48 hours in a contact injury or a sprain as it will worsen the condition and increase the amount of swelling, making recovery longer.

Where things can be a little grey is when to apply heat after undergoing surgery ( if at all) or if it is an older sprain that keeps swelling up ( such as those pesky ankle sprains) or even when to use both heat and ice therapy modalities. This is where a specific prescription of heat or ice is needed and this is based on a detailed assessment of your condition, the level and type of dysfunction and/ or pain you are experiencing by your physiotherapist. For optimal recovery, your physiotherapist can then give you the correct exercises and advise on the best activities for the best recovery.