Ice or Heat? The Age Old Question

Painfully Cold, Relaxingly Hot… Repairing the body.

One of the most commonly asked questions during physical therapy is whether it is better to use ice or heat.

Typically patients like heat better because it has a warming relaxing effect providing more comfort than ice which can be much more uncomfortable. When applying ice, it is normal to experience the sensation of cold, burning, pain, and then numbing.

Heat and ice can play very important roles during the healing process.

Today I would like to discuss the healing process itself as well as heat/ice with regards to the effects it has on our tissues as well as when and how to use it.

First, let’s review the healing process. When we damage soft tissues, the body reacts by releasing chemicals to initiate the healing process by increasing the blood flow to the injury site. This increase in fluid to the area causes pain, swelling, redness and heat. This is known as the Acute Inflammatory Phase.

During the Acute Inflammatory Phase of healing, the increased fluid to the area helps breakdown broken and damaged tissues and cells to flush them out of the area so new cells and tissues can begin to repair and grow. It is recommended that the RICE principle be applied. (Rest, Ice, Compression, Elevation) Ice is a vasoconstrictor, meaning that the cold will restrict blood flow through the veins and arteries resulting in a decreased amount of excess fluid into the area. By applying Ice immediately after injury, you can reduce the amount of swelling into the area. By reducing swelling, in theory, you can reduce the amount of pain felt after injury. This phase will typically last 1-10 days. During this phase of healing, the Physical therapist will focus their treatment on patient education, goal setting, pain management, and regaining mobility.

The second phase of the healing process is known and the Subacute or Fibroblastic Repair Phase. During this phase of healing, the swelling begins to settle down and your body begins laying down collagen to start repairing damaged tissues. As collagen begins to form, it is disorganized, scar tissue. This tissue is weaker and less flexible making it more susceptible to re-injury if placed under too much stress too soon. This phase may last from 4 days to 6 months. Physical therapy through this phase will be focused on restoring range of motion, tissue and joint mobilizations to help realign the collagen fibers, strengthening, and restoring functional mobility.

The final phase of healing, the Remodeling Phase is where the tissues begin to realign, organize and mature. It’s during this phase that adding stress to the tissue will help with the realignment of the collagen fibers. The tissues begin to gain strength and flexibility. This phase may begin at 2-3 weeks and last months to years. Physical therapy during the final stage will be focused on continued efforts to achieve full range of motion, strengthening exercises to further align the collagen and restore normal function of the joints and muscles, and continued efforts to return to normal activities.

So where does Ice or Heat fall into this process? In the Acute phase, ICE can be very beneficial to the healing process by reducing pain and limiting the amount of swelling into a given area. Using heat during the Acute phase may further damage tissues and increase the swelling to the area, essentially causing increased pain and discomfort. Heat is NOT recommended during this phase.

Ice may also be utilized during the Subacute phase as the healing of tissue may leave the area sore from the collagen fibers trying to realign themselves after being treated by your physical therapist. However, heat may also be used to soften and relax the tissues, also helping with the realignment of new tissue being formed.

In the Remodeling phase which can also be referred to as the Chronic phase, heat will continue to benefit the healing tissues by warming them up and increasing their flexibility. If the exercises given to you make you feel sore, it’s dealer’s choice at this point. Whichever modality feels better for you, whether heat or ice will both be beneficial. Also, a person who is in the chronic phase may have “flare ups” or “re-injuries” and it okay to ice during these periods of time.

A general rule for using heat or ice is this; if it feels warm to touch, painful, or if the injury just occurred, try using ice to calm the painful area. If it’s been a week or more since the injury and you are feeling a general ache or soreness, try using heat to relax the area.

Typical application times for both heat and ice will be 15 to 20 minutes ON, 15 to 20 minutes OFF. If you continue to struggle with the decision of what is best; heat or ice. Don’t hesitate to call your physician’s office or physical therapist.

If you are having any aches or pains that just don’t seem to be going away, don’t hesitate to give Back in Motion a call to set up a FREE 30-minute consultation with one of our skilled Physical Therapist’s and we can point you in the right direction to get you feeling pain free again!


Andy Broomhall

Physical Therapist Assistant

Portland, Maine

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