The question I get asked most often by my patient’s is what is better heat or ice for physical therapy? Well it is not as simple of a question as you might think. Heat and ice are both very beneficial modalities in the treatment of pain. But to make the best decision on which is the better option, I think it is imperative to consider what is the cause of your pain.

So what are some of the options where heat may be best? I believe heat is most beneficial for chronic pain condition such as stiff achy muscles from inactivity or long term muscle tightness from poor posturing or sustained posturing. Heat is vital to increase circulation and bring new blood flow and nutrients to our tissues and muscles to aid in healing. There are a lot of ways to heat up your muscle and other tissue other than just applying a heating pad. Exercise is one of the best ways to heat up tissue and muscle and bring in new blood flow and circulation to carry out toxins and waste deposits that settle in these tissues.   Also it is important to talk about how long you should stay on heat. When using a topical heating pad, we recommend using it for a period of 15-20 minutes at a time and making sure that you spend at least an hour in-between without any heat. You take the risk of overheating tissue and increasing inflammation which can in turn increase pain if you are not careful.

So when is ice the better option? I tell my patient’s that ice is nature’s anti-inflammatory. So ice is typically my go-to first especially if the pain is coming for a red inflamed joint, after an acute injury or when soreness occurs following exercise or manual therapy or massage that increased the heat in the tissue. Cold treatments like heat are good in moderation. After someone has surgery and the surgical area is producing inflammation at a rapid rate to heal the damaged tissue ice can be used practically around the clock, but when the inflammation process is a little more chronic in nature like an arthritic joint that may be flared up on occasion using ice for 10-15 minutes at a time can be enough to ward off the inflammation process that can be adding to your pain.

So when is too much of a good thing…not? Why especially when you are dealing with heating and cooling muscle and other soft tissues in the body? Well the body must maintain homeostasis. So if we use too much ice, for too long we may in turn end up increasing inflammation as the body will start to send more blood flow to that area to warm the tissues back up and prevent a cold injury or tissue death.

I also am asked if it is good to alternate heat and cold. I do believe this can be beneficial as well especially when working on increasing circulation to pull out stagnate swelling. I recommend ending with the modality that best treats the beginning aliment. So if acute and hot end with ice and if sore and stiff end with heat.

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