By Joon Nah - Certified Vestibular Physiotherapist and Founder, Therapia

Applying heat or ice to a painful injury or condition is one of the oldest, most common and easiest ways to treat your own injury. But the discussion over which to use can be contentious. The reality is that both of these treatments are generally safe so even if you choose the wrong one, it is unlikely you will make your problem a great deal worse. That being said there are a few guidelines to help you to make the best decision possible.

When do I use ice?

Use ice when the following conditions are true.

The problem is relatively superficial (close to the surface of your body)

Your body is very good at maintaining your core temperature at an optimal level so the cooling effect of applying ice to your skin does not penetrate very far. With this in mind it does not make much sense to apply ice to something that is more than a centimeter or two below the surface.

Inflammation is present

Ultimately we use ice to treat inflamed tissue. The idea is to reduce the pain of inflammation and to try to reduce swelling of the tissue. Inflammation is present when you can see redness, swelling and the area of the body is warmer than normal.

The injury occured Recently

It makes sense to Ice a recent injury for up to about three days. After this, most injuries will have passed through the initial inflammatory stage.

There was some trauma

Injuries that are the result of a trauma where tissue has been damaged will create an inflammatory response that will be appropriate for icing.

Precautions

• Apply ice for short durations (10-15 min.) and then remove and allow the area to return to it’s normal temperature. This will help you to avoid the risk of frostbite.
• Have a barrier between the ice and your skin especially if there is any break in the skin. Make sure that the material touching your skin is clean and dry.

Inspect your ice packs regularly. Commercially available, reusable ice packs can make things much easier, but some of them are prone to leakage. So check the pack regularly to make sure it is in good condition.

When do I use Heat?

Heat has the similar goal of trying to reduce pain, but should be applied under the following conditions.

The Condition is Chronic

If this is a problem you have been dealing with for a long time, it will be more chronic in nature and therefore is less likely to have an active inflammatory component. Heat can be used in this case. The notable exception is if you suffer from a systemic inflammatory condition such as rheumatoid arthritis.

Achy Muscles

Muscles that ache without having had a recent trauma may respond well to heat.

Precautions

• Whenever you use heat there is a risk of burn. The idea is to apply mild comfortable heat. More is not better in this case!
• A hot pack that is moist will conduct heat more effectively so may not need to be heated as much. Keep this in mind when trying to find the right balance.

So, Do They Work?

People have been using heat and ice for a long time so it must work right? Well…..it is not that simple. There is insufficient evidence to suggest that icing will be effective at reducing swelling or inflammation. And in studies it is not totally clear how much of a pain reduction people report with either modality. However, patients regularly report being able to manage their pain better by using heat or ice. Given it is safe and inexpensive it is certainly worth a try!

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