Ask the Chiro: The Difference Between Heat vs Ice

In this edition of “Ask the Chiro,” we will take a look at another common question that comes up a lot i the everyday patient, Heat vs Ice. Both are modalities used to reduce pain and increase function, yet many questions come up when discussing the two. Specifically, should I heat or should I ice an injury? Which is the best? How long should I heat vs ice? When should I heat vs ice an injury? The battle between heat and ice, fire and water, has been one of the most epic debates in modern day history. We will attempt to sort this out once and for all.




The Affects of Heat vs Ice:

The affects of heat vs ice are fairly simple. Heat is a modality that when applied to the body causes blood vessels to dilate or open, which INCREASES the flow of blood to the areas applied. This has many influences for the area and as we will talk about later, determines when to apply. For the most part, the increase in blood flow will warm up a sore or stiff joint and will increase nutrition and supply to the affected areas. Heat can also increase inflammation and edema to an injured area. Vasodilation and an increase in blood carries pro-inflammatory white blood cells to the area. The distribution of blood to the area can also lead to edema, which is the collection of fluid outside of the vessels also known as swelling. Although these factors are needed for healing, excessive amounts from improper application of heat can increase the severity of certain conditions.


On the other hand, Ice is a modality that when applied to the body causes vessels to constrict or close. This DECREASES the flow of blood to the areas applied which subsequently decreases both swelling and the inflammatory response in the body. It also has the ability to decrease pain by numbing the area when applied correctly.


What Types of Injuries to Heat vs Ice

So when do we apply heat vs ice? This is a very commonly confused concept, so for this article we will attempt to make this as simple as possible by splitting the two into two scenarios. The first scenario is chronic vs acute conditions. The second will be muscle soreness vs spasm.


Even the greatest video games of all time struggle with heat vs ice.


For acute vs chronic conditions, we are separating long term injuries caused by wear and tear such as arthritis and short term injuries often caused by trauma like a sprained ankle. For chronic conditions, heat is a more beneficial application as the increase in blood flow supplies nutrients to stiff muscles and joints. This helps warm the joint up which allows for increased motion. Ice is best for for these acute conditions where the goal is to control inflammation and swelling. Remember that heat will INCREASE inflammation and swelling in these acute conditions.


In cases of muscle and joint soreness vs muscle spasm, heat is best for soreness and ice is best for spasms. Icing, however, can be used for either. The real issue is during an ACUTE spasm, heat can cause a large amount of inflammation, and subsequently more contraction of the spasm. I have seen many patients who tell me they woke up with an extremely tight and spasmed back and though a hot shower would help. The result is them barely being able to bend over afterwards, as the inflammation and swelling rushes into the area as blood flow is increased.


Proper Timing and Utilization of Heat vs Ice

As you may have noticed, there are number of times when heat can be just as detrimental to a condition as it can be helpful, but that I haven’t really talked bad on ice at all. This is because, for the sake of simplicity, ice can’t really hurt you. The worst ice can do is not work. Heat on the other hand can be the trickier modality in its application, and in some cases (like a spasm) could either help or hurt you. So here are a few “timing tips” for when to use or not use heat.


First, the 72 hour tip. Heat should not be used on spasms, sprains, strains, or other inflammatory or swelling prone conditions within the acute window of injury. Basically, within the first 3 (or even 4) days no heat should be applied to an injury that is undergoing spasm or is prone to inflammation or swelling. After this window of time, it is less likely that increasing blood flow at the rate that heat allows will will result in excessive inflammation and edema, as the condition is likely past the inflammatory phase of healing.


Even if you were a kid in the 90’s, you understood how hard the decision between water and fire was. HOW DO YOU CHOOSE?!


Second, and most important tip: “When in doubt, ice first.” As I noted before, ice is least likely to hurt you. So if you are confused as to which modality to use and do not have the guidance of a physician to decide for you, this is always the safest bet. If you have iced for a significant amount of time with no results and you are out of the 72 hour window, go ahead and heat.


Finally, the last tip is about timing and application. First, with application to either modality, ALWAYS provide a barrier between the modality and skin to avoid burning. This could be your clothing, or a towel Timing for ice should be about 20 minutes, but it is important to focus on moving through certain “stages” in order to ensure proper icing. Icing should take you through a cold, burning, and finally numbness stage. It is important to get to the numbing stage, as this is where we get the most pain relief. So if you get to 20 minutes and don’t feel numb, keep going. For heat, 10 minutes is fine, and the goal is to loosen the body up. Finally, timing. Heat is best used before activity, and ice is best used following activity. There is not much benefit in icing before a practice or workout, but will help recovery by cutting inflammation and thusly soreness at the end of a hard training session, or while pushing through an injury and still maintaining full participation.


For any further questions, or to schedule a visit at Mid-South Spine and Sports Performance, feel free to call 901-573-2526 or email us at

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