Category Archives: Hot and Cold Therapy

Heat or Cold Therapy?

Do you know when to use ice vs heat?  It is a question we often get asked at the clinic.  The rule of thumb is to use ice during the inflammatory phase of injury and heat during the remodeling phase or for chronic pain.  The first 24-72 hours after an acute injury or an exacerbation injury marks the inflammatory phase.  The telltale signs of inflammation are pain, redness, swelling, warm and tender to the touch.  If these signs are present then ice is the modality you should use for pain relief and the acronym RICE comes in to play.  Thats:  Rest, Ice, Compress, and Elevate.  Ice can be used for 20 minutes or so at a time out of each hour.  Do not leave it on continuously.

After 72 hours, or when the inflammation is down you may use heat.  Heat like ice has its limits and should not be used for more than 20-30 minutes at a time.  Alternating heat and ice after the inflammatory phase is a protocol that I frequently recommend.  To do so you can heat for 20 min, ice for 10, heat for 20… you can repeat this cycle as many times as needed without the concerns associated with leaving just one on for too long.

Those are the general rules.  However, suppose you are an athlete with an overuse injury (think baseball pitcher).  Well even though that shoulder is technically a chronic injury, it becomes acutely affected and inflamed when pitching.  So immediately after the game you would use ice rather than heat.  While before the game heat may have been used to aid in loosening up the stiff joint and tendons.

Hope this helps clear things up a bit.  If not give us a call!

In Health,

Frank Jay Lagoni, DC