Heat vs Ice: Which Should You Use?

This is one of the most frequently asked questions I get as a physical therapist. Shakespeare himself once wrote “to ice, or not to ice, that is the question”....or at least he would have if he’d been a PT. So, let’s break down the question and get some clarity!

What Does Heat Do?

Heat makes things expand: think of putting a peep in the microwave. When you apply a hot pack to your body the underlying blood vessels and lymphatic vessels (which regulate fluid) expand. This is why the skin under a hot pack turns red, it’s due to increased blood flow!

How Does Heat Help?

Blood is the body’s delivery system. It’s how your body’s tissues get oxygen, nutrients, and other helpers (ions/chemicals) that promote equilibrium and health. If your symptoms are tightness or stiffness, OR if you suffer from muscle knots and aching, increasing blood flow to the area with heat is likely to help.

What Does Ice Do?

Generally speaking, ice does the opposite. It causes body tissue to constrict, or get tighter. Think about how your hands and feet seem to shrink in the winter.

How Does Ice Help?

Hmm…ice is a bit tricky (why you gotta be like that, Ice?). Ice is often used on injuries that cause acute, painful swelling such as an ankle sprain or a swollen surgical site. In these cases, ice effectively reduces pain, and may improve range of motion if swelling is a restricting factor. However, you may have also heard about athletes using an ice bath after a game or marathoners doing the same after a long run. There is some evidence about using ice this way but it’s inconclusive. Some studies even indicate that heat may be just as helpful! Anecdotally, however, many find ice helpful in treating post exercise muscle soreness, especially if applied right away. So if you like it, use it!

The Big Takeaways:

Researchers are still gathering evidence about the effects of heat and ice during injury recovery. Both can help to reduce pain. Heat is best to promote the loosening of tight tissues. Ice is best to decrease inflammation. If you still aren’t sure, you can always ask your physical therapist about your specific injury!

References:

Clijsen R, Stoop R, Hohenauer E, Aerenhouts D, Clarys P, Deflorin C, Taeymans J. Local Heat Applications as a Treatment of Physical and Functional Parameters in Acute and Chronic Musculoskeletal Disorders or Pain. Arch Phys Med Rehabil. 2022 Mar;103(3):505-522. doi: 10.1016/j.apmr.2021.06.015. Epub 2021 Jul 18. PMID: 34283996.
Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases. 2021 Jun 16;9(17):4116-4122. doi: 10.12998/wjcc.v9.i17.4116. PMID: 34141774; PMCID: PMC8173427.
Kwiecien SY, McHugh MP. The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. Eur J Appl Physiol. 2021 Aug;121(8):2125-2142. doi: 10.1007/s00421-021-04683-8. Epub 2021 Apr 20. PMID: 33877402.
van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012 Jul-Aug;47(4):435-43. doi: 10.4085/1062-6050-47.4.14. PMID: 22889660; PMCID: PMC3396304.
Wang Y, Li S, Zhang Y, Chen Y, Yan F, Han L, Ma Y. Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials. Phys Ther Sport. 2021 Mar;48:177-187. doi: 10.1016/j.ptsp.2021.01.004. Epub 2021 Jan 14. PMID: 33493991.

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