The thing I get asked about the most in the PT clinic is, “When do I use ice and when do I use heat?” This question has been the source of so much confusion. Is it ice or heat or alternate between the two?

I recommend patients stick with ice for the first 24-48 hours after an injury. This helps decrease the pain associated with increased inflammation, resulting in red, swollen, hot and painful joints.

Heat, on the other hand, can be used to soothe pain of a more chronic nature or when the injury is to muscle tissue. I would still recommend starting with ice for an acute muscle injury; however, beyond that you want to keep the muscle warmed up and moving. Unless there is a specific incident that resulted in neck or low back pain, I find patients tend to do better with heat for these muscular pains.

How I think about it is that if I did XYZ activity and I am having more pain afterwards, I am going to try ice first. But if things are generally achy and sore, then I will grab for the heat. For example, when I twisted my ankle, I grabbed the ice initially because it got swollen and painful. I continued to use ice if I’d been up walking on it for a long time. But when it was stiff and sore first thing in the morning, I put heat on it to get it moving.

Some Examples

After you twist an ankle, immediately put ice on the area. Continue with ice for the next 24-48 hours. Then, when it is stiff first thing in the morning, use heat to loosen things up. But continue to use ice as needed if you are on your feet for an extended period and the ankle swells up.

If you take a long car ride and your back feels sore, use heat. But if you were shoveling and felt a catch in your back, use ice initially before switching to heat.

Ultimately, you will want to listen to your body and what feels best for it.