I am commonly asked when ice should be applied or when is heat appropriate. Ice and heat are physical modalities that can be applied to different parts of the body for specific reasons and effects. Although there use seems routine, it is not entirely risk free.

ICE

Ice is most commonly used in acute injuries to diminish pain and swelling and post injury inflammation. Ice is used to treat joint pain, muscle, tendon and ligament injuries such as tenosynovitis, tendonitis, strains and sprains and contusions.

Ice should be applied for 15 minutes on every 2 hours off repeating the applications throughout the day depending on the severity of the injury. Ice application should be limited to 15 minutes at a time. Longer applications can lead to potential tissue and nerve damage. Frozen chemical or gel ice packs should never be applied directly to the skin and should always be separated from the skin by a layer of cloth or paper towel.

When ice is applied to the skin, there will be an initial cold felling, which then may be followed by a burning sensation, achiness and the numbness of the area.

Common Methods of Icing:

• Ice cubes/crushed ice in a plastic bag
• Gel Ice Packs/Chemical Ice Packs
• Ice or Slush Bath-Ice and water in a pale or bucket for limb submersion
• Frozen Peas or Vegetables

When to use ice:

• Acute injuries
• Acute or chronic pain
• Acute or chronic inflammation
• Muscle spasm
• Postsurgical pain and swelling

When not to use ice:

• Cold allergy
• Decreased cold sensitivity or hypersensitivity
• Raynaud’s Disease
• Circulatory or sensory impairment
• Uncovered open wounds

HEAT

Heat is utilized to increase blood flow to an area during rehabilitation. It is typically applied before stretching exercises, joint mobilization treatments, and exercise to help improve range-of-motion.

Heat should not be applied to acute injuries. If applied to new or acute injuries it can lead to increased swelling, inflammation and pain.

Heat is applied for 15 minutes prior to stretching and exercise.

When to apply heat:

• Prior to rehabilitation or exercises to improve range-of-motion
• Increase blood flow to an area to facilitate tissue healing

When not to apply heat:

• Acute injuries
• Acute inflammation and swelling
• Poor or impaired circulation
• Diminished sensation
• Impaired thermal regulation