If I had a nickel for every time I heard this question… lol

My short answer to the question is, “If you’re feeling throbbing or burning pain, or warmth around your injury then definitely go with ice. If you’re feeling stiff, achy, tense, or stressed, then go with heat.”

The goal of using ice or heat is to get some temporary pain relief such that you’ll be able to tolerate life, sleeping, and exercising better, and require less pain medication. (Your kidneys, liver, stomach lining, and wallet will thank you for that.)

The ACOEM guidelines state in chapter 3 in the ‘initial approach to treatment – that, “Physicians may use passive modalities such as application of heat and cold for temporary amelioration of symptoms and to facilitate mobilization and graded exercises”.

In other words- we aren’t expecting ice or heat to FIX your problem, but we hope that it makes you feel a little better, and at least well enough that you can then get to the good stuff. Meaning, that you’ll be able to tolerate the exercises better- which will ultimately be what will help you get better.

How do I decide if I should use ice or heat? 

– Muscle spasms: It’s my experience that muscle spasms respond to heat 60% of the time, and to ice about 40%.

– Tension and stress related tightness: Heat.

– Stiffness and achiness: Heat.

– Soreness and fatigue: Usually ice.

– How old is your injury: If your injury occurred in the last few days- ice is a good choice.

– Swelling: if you can visibly see swelling, and when you touch it, it feels squooshy, then get some ice on there and elevate it while you’re at it. If you can see that it’s bigger as compared to the other side of your body, but when you touch it, it feels hard, then heat might be best to help the stagnant swelling flush out of there.

– Redness/warm to touch: If your injured body part looks red and feels warm when you touch it- then you definitely want to choose ice. In fact, keep an eye on it. It could be something that you’d need to see the doctor about because redness and warmth and swelling combined Sometimes (not always) means infection.

– Past injuries: if another injury in your past responded better to ice or heat- chances are you’ll respond best to the one your body liked best the last time.

– Purposeful indecision: Some people do well with alternating ice/heat. Meaning, put ice on for 10 mins, then heat for 10 mins, and alternate again.

Still not sure- send me a message!

Once you’ve decided if you’re going to try ice or heat, then here’s how to do it.

What can I use for ice: 

– You could purchase an ice pack – they are made of gel and can be used over and over again by just returning them to your freezer after you’ve used it. (I like the brand….)

– Or you could buy a cheap bag of frozen vegetables. Peas work well. I’d maybe put them inside another zip lock bag to prevent accidental spillage, and I’d mark the bag so that I don’t eat these sacrificial peas. (once you thaw and refreeze them, they’ll get a little weird).

– You could use ice – crushed ice is more comfortable than cubes.

– You could make your own re-usable gel-like ice pack by putting 1 part rubbing alcohol with 2 parts water in a double layer zip lock bag, getting out as much air as you can, and freezing it. Liquid dish soap in a double layer zip lock bag freezes like gel as well.

– If it’s a small area you are trying to calm down, you could do an ‘ice massage’ by rubbing an ice cube (or a frozen Dixie cup) over the area (great for patella tendonitis).

– A frozen water bottle also works well to roll back and forth over your injured area (great for pain in your arch/plantar fasciitis or your hand or forearm).

– Then there’s the ice bath option… I’m not a huge fan of this – but if it’s along the lines of splashing around in the cold pacific after a hot and sandy volleyball match, now that could be understandable! Ha.

What are the parameters for using ice: 

Whatever you choose to use, you want to be sure you have a layer of material between your skin and the cold thing (except in the ice cube massage and ice bath situation). Leave the ice pack on for 10-15mins. If you’ve got an area of low circulation- like your finger tips – less time than that will do the trick- you want to watch out for frostbite. If you’re doing the ice cube massage technique- that usually only takes 3-5minutes to get the full benefit. As you’re ‘massaging’ the small area (no bigger than 2-3X’s the size of the ice cube) you’ll feel the skin get cold, then burn a bit, then go numb. Tap it with your finger, and if you can’t feel yourself tapping, then you know it’s been long enough.

If you’re in the polar bear family and want to try the ice bath, then here’s some things to consider. Some athletes will submerge their entire lower body. I wouldn’t suggest that unless you’ve got supervision and direct instruction for your situation. But if you’ve got a body part that can easily be submerged, like a foot, then 54-60degrees, and no more than 8-10 minutes should do the trick.

What can I use for heat:  -heat is a little tougher to come by than ice but there are still a lot of options.

– You can purchase an electric heating pad. They plug into the wall and have an on/off switch. The electric coils are basically inside a towel layer. Typically it’s big enough that it can cover your whole backside, or it drapes nicely across your shoulder, etc.

– You can make your own heat pack. Use a long sock or a small pillowcase. Fill it with around 6 cups of uncooked rice. Optional: add a few drops of essential oils for fragrance if you’d like. Sew the end or tie it off (don’t skimp on this important step!). Then microwave it for 1-2 minutes (give or take- you know your microwave better than I do).

– A hot shower is a good way to deliver some moist heat- but it does have it’s limitations in the convenience department.

– A hot tub or sauna are nice if you have that available to you as well.

What are the parameters of using heat?

How long should I put the heat on for? I’ve had people feel relief within seconds of applying a heat pack. You’ll probably get the biggest effect between 10-30minutes. It’s never advisable to fall asleep with the heating pack turned on. People are often tempted to stay in a hot shower for a ‘long time’. Your hot water bill will let you know if it’s been too long, as will your skin. Staying too long in a hot shower can dry out your skin and even make it itch. Though long showers are tempting, some experts advise no more than 10mins, and no more than once per day. In regards to hot tubs and saunas, we must consider the dangers of overheating and becoming dehydrated. 10-30mins is the typically advised range, but please consult with your MD for specific suggestions for your personal health concerns.

Safety tips summary:

If you have diabetes or some other condition that decreases your ability to feel things on your skin, you should take much caution.

Always put a towel layer between your skin and the ice/heat.

Leave ice on no more than 15-20 mins. And if it’s a small body part with compromised circulation (like the tip of your finger) even less time is advised to protect against frost bite.

If you are overweight you are more prone to overheat. Speak with your doctor about safety with hot tubs and saunas.

Don’t fall asleep with the ice/heat on you.

Health science isn’t an exact science, and I have occasionally seen people respond better with the opposite of what we originally thought was the best option.

You’ll know if you’ve responded well if you at least get temporary relief from using ice or heat.