Healthy Minute: Heat vs. Ice – Which is Best?

Healthy Minute: Heat vs. Ice – Which is Best?

To help recover from an injury, which should you reach for — the ice pack or the heating pad? Follow these guidelines from Rich Green, a physical therapist and DMOS Orthopaedic Center’s Director of Physical and Hand Therapy, and you’ll never have to wonder again:

Ice vs Heat Infographics - Which is best?

For an acute injury, apply ice.

Why ice?

Ice is a vasoconstrictor, which means that it constricts your blood vessels. When you experience an acute injury – an injury that occurs suddenly and that often includes pain and swelling – your body will have an inflammatory response to try to protect the injured area. Applying ice will slow blood flow to the area and reduce the pain, swelling and reduce muscular function associated with your acute injury.

How long should I ice?

Apply ice to the injured area for 20 minutes on, followed by one hour off. If you ice longer than 20 minutes at a time, it will restrict oxygen flow to the injured tissues and slow the healing process. Follow this routine of 20 minutes on, one hour off for the first 48 hours after your acute injury.

“The biggest mistake I see is putting ice on for too long,” Green said. “If you leave ice on too long you actually encourage inflammation, so be sure to remove it after 20 minutes.”

How should I ice?

You can “massage” the area with an ice cube or use an ice pack or bag of frozen vegetables. To make a homemade ice pack, try Green’s favorite DIY: Fill a baggie with 2/3 water and 1/3 alcohol to prevent the water from freezing completely and to keep the bag flexible to mold around your injured area. Then put it in a second baggie so it won’t leak. Keep it handy in the freezer for the next time you need an ice pack.

What else should I do during the first 48 hours?

Remember the acronym PRICE:

  • Protect the injured tissue from further injury.
  • Rest. “We like to say that ‘motion is lotion,’” Green says. “Rest doesn’t mean to do nothing. Maintain some gentle movement of the injured area, but listen to your body and don’t do anything that feels like it’s exacerbating your injury. Listen to your body. If you’re not sure how much movement is appropriate for you, talk to your physical therapist.”
  • Ice 20 minutes on followed by one hour off for the first 48 hours
  • Compress with a light ace bandage and Elevate the injured limb above your heart to help blood flow and prevent accumulation of swelling in one area.

After 48 hours, apply heat.

Why heat?

Heat is a vasodilator which means that it dilates your blood vessels, “flushing” your system after the initial inflammatory response of the first 48 hours.

How long should I use heat?

Starting 48 hours after the onset of your injury, use heat for as long as pain and swelling associated with your injury persists. Follow the same schedule you did with ice, applying heat for 20 minutes on followed by at least one hour off.

For a chronic injury – use heat and cold.

If a long walk exacerbates chronic knee pain, or too much typing always makes your wrists feel sore, try an ice pack for 20 minutes right after the activity. Then if you’re still sore after an hour, try a heating pad for 20 minutes.