I get asked on a weekly basis: Which is better for an injury, heat or ice? The answer depends on several factors. These include location of the injury, acuity of the injury, if there is swelling, if you are treating muscle spasm, stiff joints, etc.
If you had a recent surgery, the recommendation is usually ice.
For a post operative knee, hip, foot, ankle, etc ice is the recommendation. This is because after a surgery swelling occurs as a natural step in the healing process. Edema (swelling) causes pain and restricts movement. We only need a small amount of swelling to start the healing process. Therefore, we want to reduce excessive swelling with icing and elevation (unless it’s your shoulder – that’s already above your heart and doesn’t need to be elevated for icing).
For muscle spasms, heat can help the muscles relax.
When a muscle is in spasm it is contracting when it shouldn’t be. This causes a lot of tension and makes it difficult to relax. Applying ice to the muscle encourages it to tighten up. Unless someone has an aversion to using heat, I apply it to tight and irritated muscles.
Here is one example of when I use heat. Sometimes my post operative knee patients have lingering tightness in their quadriceps or hamstring muscle groups that interfere with their range of motion. I may place a hot pack on their upper thigh while we slowly bend their knee, to encourage the muscle to let go and move through an increased range of motion. Please note that the heat is on the part of the muscle that is farthest from the surgical joint. Use of heat in this scenario helps the guarded muscle to relax.
Here is another example: A patient arrives with severe back pain which includes muscle spasms. While providing some hands on work I might apply a hot pack to encourage the muscles to relax. I like to work on the muscles and/or joints, sliding my hands under where I placed the hot pack. Usually I leave the hot pack on for about 10 minutes, depending on the person.
Other situations where I recommend heat is on arthritic joints, and stiff necks
Most individuals with osteoarthritis have the most pain first thing in the morning. People tend to report that after moving around the pain resolves within an hour. When treating an arthritic joint, I apply a hot pack to the joint while working on improving range of motion. This helps get the joint moving more comfortably. With the hot pack still on, we work on gently and gradually moving the joint through an increased range. This may look like slowly moving someone’s shoulder into an overhead position, or slowly bending someone’s knee.
Patients with neck pain typically come to me with joint stiffness as one of their symptoms. These individuals usually respond well to heat while I perform some joint mobilizations (stimulate each individual joint with my hands to gently encourage movement).
The purpose of the heat in both of these scenarios is to encourage joints to move more easily.
If you have a sudden twist or awkward movement of a joint, I typically recommend ice.
These are events such as ankle sprains, knee twists, awkward positioning of the shoulder, etc. When you injure a joint I recommend ice to manage the swelling and pain. As mentioned previously, excessive swelling presses on receptors in the surrounding areas and increases pain. You can combat this by icing and elevating the affected joint.
The decision to choose heat or ice for pain management is dependent on the pain driver.
Here is what I mean by “pain driver”: Is the cause of your pain a recent injury? A strained muscle? Gradual inflammation in your joints? The answers to these questions matter when you’re deciding how to manage your pain.
I’d like to add that using ice or heat is not usually enough to manage any of the conditions referenced in this post. If you’re having lingering pain, please see your provider for guidance on the next steps.
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