The Age-Old Question: Ice or Heat?

This is a question asked physicians daily, often on multiple occasions. Let’s first begin with a general break down of the outcome of each modality.


Cold: reduces blood flow, which leads to a reduction in edema and inflammation. It also reduces metabolic demand and has been reported to reduce pain.


Heat: increases blood flow, which in turn increases metabolism and leads to an increase in the elasticity of connective tissues, i.e. the fascia around the muscles. It can reduce muscle tightness and has also been shown to reduce pain.


What you may not know is that many of the research articles written and cited on this topic don’t show a significant statistical difference in pain reduction with ice vs. heat. So, if you are making your decision based on which will reduce your pain, well grab a coin folks. In fact, most recommendations given on this topic are based on the physician’s personal preference or the patient’s preference.


My recommendations vary based on the presentation of the injury. The factors that come to mind when making this decision are the level of swelling, the area of swelling, and the mechanism of injury. I also take into consideration how long the patient has had the injury before they come and see me. That is why it is so important to see a physician specifically trained in sports injury when you do sustain a soft tissue injury. I also use a combination of both modalities at varying time intervals for subacute and chronic injuries. I typically will have the athlete incorporate heat much earlier in a situation where return to play is being considered. I also have some patients use ice a lot longer than others if they have underlying chronic inflammation. It just depends on the presentation. Below are some hard and fast rules I do follow:


1. If the swelling has been present for greater than one month and the patient has been cleared for any underlying fracture, dislocation, tear, severe sprain, etc. then I am typically recommending the use of both in an alternating pattern.

2. Mechanical motion is the most underutilize therapy when working on inflammation reduction. Motion in any synovial joints also leads to the influx of substances our body naturally produces to clear out damaged tissue. So more important to me is the idea to get the patient moving as soon as safely possible.

3. If ice or heat cause the patient pain that last greater than 5 minutes beyond the treatment time, they are to stop using said therapy.

4. Extreme temperatures and times should not be used with either modality as it can lead to skin damage. Also, when utilizing ice packs, a barrier is often recommended.

That’s my two cents folks! If you have any more questions on specific injuries, please feel free to contact us.


Have a spectacular week!


Cindy VanSickler, DC, CCSP, Cert. MDT



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