Should I use ice or heat on my injury?

Ice PackJill Murphy, DPT, LAT, CSCS

Contributed by every patient we meet :)

Question: Should I use ice or heat on my injured ______?

Answer: We really do get this question from everyone we meet in our clinic. When do you use ice, when do you use heat, and when do you switch from one to the other? Well, I have to admit my biases here. While I practice primarily as an orthopedic and manual physical therapist, my first background was as an athletic trainer, where returning to activity ASAP takes on a whole new meaning. Hands-down, the treatment we utilized most often in the athletic training room was ice. Heat is a nice way to warm a nearly healed muscle before activity, or to warm very tight muscles and soft tissue in the neck before treatment. Other than that, every joint and every injury received ice. Ice is an excellent way to control and reduce swelling and reduce pain without any adverse side effects if done properly. Heat can increase swelling if applied too soon following an injury or surgery, and while it can decrease chronic swelling by increasing circulation, its best use is for muscles that are tight in the neck and upper back.

My patients frequently remind me of the “But you should only ice for 24 hours right, and then you're supposed to use heat after that!” Well, if you have ever had surgery or suffered a significant injury, then you know that the acute swelling from these insults lasts far more than 24 hours, more like 1-2 weeks. And then you are performing exercises and light work-outs to recover from your injury, and your pain and swelling increases after each exercise session. This too is acute swelling, for which ice works very well. Apply heat in this situation, and you very well could increase your discomfort. So, when in doubt, especially for joints like the knee and ankle, shoulder and elbow, and even in the low back where joints tend to cause pain more than muscle, always ice, except for the neck and upper back, for which heat is probably the best advice for most circumstances (other than very recent surgery).

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