Should I ice or heat?

I hear this question in many situations where someone may be having neck or shoulder pain because their muscles are feeling knotted up (see blog entry #1), post-op such as after a total knee replacement or post injury like an ankle sprain.

Ice and heat can both help with pain, but they have the opposite effect on circulation and tissue extensibility. A very good general thought process can be as follows: if you are feeling ‘tight’, heat will help loosen you up and probably will feel very nice. If you are feeling “flared up” for example immediately after exercise, or if you have a sprained ankle, spent some time walking through the mall and now you are swollen and sore, ice will help calm the inflammation down.

Again, both will feel good but what you don’t want to do is prolong inflammation by heating tissue that already has excessive blood flow coursing through it. Let’s use another common scenario: tendinitis – an inflamed tendon. Tendinitis may often feel very stiff in the morning, likely from a night of rest where inflammation around the tendon as settled and your body may have started to grow new tissue to heal it. Immediately in the morning, it may be ok to heat the tendon and muscle to improve extensibility (stretching also improves extensibility and blood flow and is probably a better option). However, if the inflammation never fully resolves, the healing process will get stuck in a cycle of inflammation so generally, ice is best because it decreases blood flow. It’s generally never a good idea to heat tendinitis toward the end of the day or after activity when the muscle has been in use or is fatigued.

What about alternating ice and heat? I like this idea. For ‘stiffness’, not necessarily, But when you’re feeling inflamed, yes. Heat will again likely do a nice job of helping with pain, but the by following it with ice you get the benefits of vasoconstriction (closing of your blood vessels) and longer-term benefits of decreasing inflammation to help with healing. Multiple heat-ice rounds is fine, just finish with ice.

Lastly, if you are fresh out of an injury, remember this acronym: PRICE.

Pressure. Rest. Ice. Compression. Elevation (above the level or your heart). This has everything to do with inflammation. Inflammation is only phase 1 of healing. We need it to start healing, but then we need it to go away so our body can finish the rest of its process of growing new tissue. In this case, you could ice 5x/day, 20 min per session as long as you are feeling red, sore, and swollen. Just don’t give yourself frost bite!


All the best,

Dr. Jesse Roles, PT, DPT, MTC