Ice vs. Heat?


By: Dr. Peggy Malone


I have been suffering with a sore neck in the past few days after tweaking it while shoveling snow.  I have to admit that I have been complaining and moaning and groaning and annoying John quite a bit.  


Today after he asked me what I would tell a patient with the same complaint (isn’t he so smart?) I finally decided to take my own advice and put some ice on it…..and wouldn’t you know…I feel better 🙂


The ice versus heat question is one that is age old and never ending. Everyone is confused about the answer to this question depending on the type of injury, how long ago it happened, and the alignment of the planets 🙂


You will get a different answer to this question depending on the practitioner you ask and the particular injury you might be dealing with.  


To try and simplify things and give you some tips that you can use when you are dealing with pain and injury, here is the way I explain it to the patients and athletes in my practice based on the literature I’ve read as well as personal and clinical experience:


Although it’s a bit more complicated than this…think about it this way as 2 basic concepts.  


Cold causes vasoconstriction of blood vessels (the blood vessels shrink and get smaller). This decreases blood flow, swelling and inflammation.


Heat causes vasodilation of blood vessels (the blood vessels open up and get bigger).  This increases blood flow and potentially brings swelling and inflammation.


Ice therapy and treatment is one of the simplest, safest, and most effective self-care techniques for injury, pain, or discomfort in muscles and joints. 


Icing an injury can significantly help with decreasing pain and inflammation, and speed up recovery time. Ice therapy is very safe and effective but there are some precautions that must be followed. 


Ice should never be applied directly over the skin for a prolonged period of time as this can damage skin tissue. A wet towel can be used as a barrier between the ice and skin and acts as an excellent conductor of cold.


Ice should not be applied before exercise or activity as this impairs your body’s ability to detect proper joint and muscle function, making you potentially more susceptible to further injury. 


Ice therapy should also not exceed the treatment time recommended. I usually recommend 10-15 minutes every hour.


Ice is generally recommended for acute injuries (under 72 hours old).  This makes sense when we go back to the basic concepts I mentioned above.  When an injury is new, you want to decrease blood flow to the area and control the swelling and inflammation.  


Keep in mind though that ice may also be used for chronic conditions, such as overuse injuries in athletes (Shin Splints or Plantar fasciitis). 


Many people assume that if the injury has been around for weeks or months, that ice isn’t going to help because they have heard that you should only use it for the first couple of days after an injury.


In these cases though, ice can be extremely helpful and should be used on the injured area after activity (10-15 minutes) to help control new inflammation that may be stirred up during your run or activity. 


So even if the injury has been around for weeks or months, it is always relevant to continue to use ice post activity if you are having pain or discomfort. (Don’t use ice before activity in chronic cases)


Heat can also be a great tool in helping with offering relief and aiding in healing. 


Heat treatments are commonly used for chronic conditions to help relax and loosen tissues, and to stimulate blood flow to the area. Going back to our basic concepts above, this works as the blood vessels dilate and increase blood flow to the injured area. 


Use heat treatments for chronic conditions, before participating in activities or before stretching or massage or other bodywork treatments.


Do not use heat after activity, and do not use heat when you have an acute injury. 


Heating tissues can be accomplished in several ways.  Many people use heating pads on the area of injury.  I usually don’t recommend this but instead encourage my patients to use whole body heating like a hot shower hot bath or hot tub.  


This will cause vasodilation in many of the body’s blood vessels which will help to flush out inflammation from the area of injury instead of just bringing more blood and potentially more swelling and inflammation to the same place.


I usually recommend 10 to 15 minutes of heat only and then I encourage my patients to use cold after the heat treatment.


So….simply….warm up the tissues to bring blood flow to the area, do your activity or treatment, then cool down the tissues using ice therapy to reduce swelling and inflammation.


And if you aren’t sure if you should use heat or ice….go with ice for 10-15 minutes.


I was reminded today with my own neck pain how helpful these simple tools can be and the relief they can offer.


Until next time…


Live Well,





Dr. Peggy Malone is a Chiropractor and an Athlete who helps other athletes to overcome injury and get back to their sport. Her weekly Television Series 'Living Well" inspires people from all walks of life to take control of their health to be as happy and as healthy as they can be.

A former varsity Basketball and Rugby player, she has since entered the world of endurance athletics where she has completed 2 Ironman Triathlons, 3 Marathons, several Half Marathons and many other Triathlons, Road Races and Off-Road Adventure races of varying distances.

Her own athletic endeavors and injuries have given her valuable insight into working with athletes in her practice for both the care of injuries as well as for the improvement of athletic performance.

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