Should I use Heat or Ice?

This is a common question that is frequently asked around our clinic. The truth? Both can be effective modes of pain relief, if used correctly. First, let’s discuss the various effects of each treatment modality.

Cryotherapy is the application of ice for therapeutic benefits. Ice decreases the temperature of soft tissue and results in vasoconstriction, or the narrowing of blood vessels, to provide pain relief, reduce tissue extensibility, and reduce inflammation. Tissue metabolism slows, as well as neuronal responses, to reduce the severity of tissue injury. Types of ice that can be applied include: reusable ice pack, ice baths or cooling gel/spray.

 Thermotherapy is the application of heat for therapeutic benefits. Heat increases the temperature of soft tissue and results in vasodilation, or the widening of blood vessels, to provide pain relief, improved tissue extensibility, and increased oxygen uptake for tissue repair. It is also important to note that heat encourages the break down of damaged tissue. Types of moist heat that can be applied include: hot packs, hot water bottle, moist heating pad, warm shower or warm bath.

But which modality should you use and when? Well, that depends on the type of injury and stage of tissue repair. After trauma, the body initiates the healing process which consists of three main phases.

1. The first phase is known as the inflammatory phase of healing. This phase is characterized by swelling, heat, redness, and pain. The inflammatory phase begins a few hours after the injury occurs and lasts 1-3 days. Use ice during this phase! Do not use heat during this phase as it can worsen the inflammation.

2. The second phase of healing is known as the proliferation phase. This phase is characterized by the production of repair tissue (i.e. scar tissue). It begins about 2 days after the initial injury occurs and can last for 2-3 weeks. Heat can now be applied to facilitate healing.

3. The final phase of healing is known as the remodeling phase. This phase is characterized by maturation of the scar tissue that was developed in the previous phase. The main goal of this phase is the full restoration of tissue function. Heat is recommended during this phase to reduce stiffness.

Ice is best when applied to recent, superficial injuries. Heat is best for chronic, deep aches and pains. While certain phases of healing respond differently to ice and heat, both modalities are equally effective and safe pain relievers. Your own personal preference plays a major role in symptom response.

The bottom line is use what works best for you! If you start to use one and don’t like it, then try the other one!