Northside Hospital - Ice vs. Heat

Ice vs. Heat

Dr. Joseph Powers

What types of injuries respond to ice or heat?

The question of ice versus heat is one I am asked on a daily basis. Surprisingly, there is little research on the subject, despite our frequent use of both.

Ice will restrict blood flow and numb the area to which it is applied. I generally recommend ice for acute (new) injuries or when trying to reduce swelling and inflammation. Given the restriction in blood flow, avoid ice for more chronic (~6 weeks old) injuries as it can limit healing.

Heat, on the other hand, increases blood flow and can loosen stiff, sore tissues. This tends to be more helpful for chronic injuries. I generally recommend against using heat on acute injuries as it may worsen swelling.

Are there injuries that respond to both therapies?
Depending on your underlying condition, there are different strategies you can employ to help your recovery. For example, if you have recently begun suffering from tendinitis, you may consider using ice to help calm the area and decrease pain. If your attempts at healing the area through stretching, strengthening and activity modification are unsuccessful and the pain lingers, consider switching over to heat. Once again, this can help improve blood flow, which may help with tissue repair.

Alternatively, if you suffer from joint pain, from chondromalacia (thinning of the cartilage) or mild arthritis, consider heating before exercise to loosen the joint and surrounding soft tissues. After exercise, if you experience pain or swelling, switch to ice. Although this may stiffen the joint, it may provide pain relief.

Back pain is another area in which ice and heat are commonly used. There have been very few studies that have looked at the question of which is better in significant detail. Most suggest short-term applications of heat, especially when coupled with exercise, are most beneficial. Ice does not appear to show much improvement in symptoms for the majority of patients with back pain.

What is the best way to apply heat or ice?
There are a variety of options that can be used. When applying heat, you can use either dry or moist heat. Both can be effective, with some suggesting a slight edge toward moist heat. Hot water bottles, grain-filled hot packs, hot towels, baths, saunas, steam, heating pads and wraps are some of your options. Cold treatments include cold towels, ice packs and gel packs to name a few.

Is there an idea amount of time to leave ice or heat on an injury? Duration of treatment can vary depending on how you are applying and your goals. For ice, you generally want to go with shorter time periods, 10-15 minutes at a time, to avoid irritating the skin. Heat may be used for slightly longer periods, up to 20 minutes, but you still want to avoid overdoing it. For more widespread muscular irritation, a longer soak in a warm tub may be called for. If you have certain conditions such as neuropathy, diabetes, vascular disease or skin issues, you should consult with your physician before using ice or heat due to the potential for complications.

Dr. Joseph Powers is a board-certified physician with the Northside Hospital Sports Medicine Network. He specializes in non-operative orthopedics and sports medicine. For more information, visit:


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