The old heat versus ice debate. People often ask me what they should do. My simple answer? Heat before activity and ice afterwards. There is actually a lot more that goes into this answer which we will get into.

Inflammation is GOOD! … At First

During the first few days after an injury, you want to ice. Listen, I don't like ice either. I'm always cold so I would much prefer heat to warm myself up. After an initial injury or surgery, an inflammatory process is occurring. This is okay! Inflammation is a natural part of healing that you don't want to interrupt. This is the process that brings blood and oxygen to the injured area that helps with healing. Typically, when people think of inflammation they think "bad." I'll say "bad inflammation" is typically what lasts longer than 7 days. During the acute phase of healing, which is typically the first 7 days after an injury, the body is trying to bring healthy tissue and supplies to the area to help with healing. It is when the swelling and inflammation lasts too long that it is "bad." There is a lack of blood flow to the area from the excess swelling, so new nutrients are unable to the damaged tissue. That is why at first after an injury you may have heard of RICE: rest, ice, compression, elevation. This allows the body to rest and recover what it needs without causing further injury. However, I will note that if you have had an extensive and invasive surgery, please be mindful that swelling and inflammation easily can last longer than 7 days which is okay!!! That is expected. Consult your medical provider if you have any concerns.

Other Indications for Heat vs Ice

As for the rest of the time outside of 7 days. Heat and ice have several different applications in which they are warranted. Heat helps to stimulate blood flow circulation, it helps muscles to relax, and it increases the speed at which nerves send signals to the brain to name a few. Ice on the other hand decreases inflammation, decreases nerve signal speed to the brain, decreases circulation, and cools the tissues. My general rule of thumb: heat before activity and ice after activity. Once a patient said to me, "Oh so like you do a warm up before you exercise and cool down after." I loved that. It is an easy way for people to remember, because most people have heard that statement before. Usually, I say to heat before activity or first thing in the morning because the bones, joints, and muscles are stiff after not moving around for a while. If you heat, it helps to prepare the muscles and body to move. It gets the blood flowing to the area and the muscles loosened up. After activity, ice is usually beneficial. As you are moving around, you may be causing some inflammation, which is okay! That is why icing afterwards helps to CONTROL the amount of inflammation. This may prevent the amount of pain that you feel afterwards. Remember, ice decreases how fast signals are sent to the brain? That includes pain signals. This is why you hear of a lot of sports players taking ice baths after games or matches. Again, going back to, "I don't like ice because I don't like to be cold." I've found that gel ice packs are my favorite. They are cold enough that they ice the specific area that you need, but they don't make your entire body cold. Not only that, but they also can wrap and form around the body part that you need to ice, ensuring full coverage. Finally, around the time that they start to warm up and not be as effective is around the time that you're probably done icing anyway, 10 to 15 minutes.

The infamous PT Saying: "It Depends"

"What if it is in the middle of the day, and I'm not doing anything but I'm having pain?" This is a tough question because you may need to figure out what is causing the pain. Is it a muscle spasm and the muscle is tight and pinching on a nerve? Well heat may help because it relaxes muscles. Is it from a nerve firing because it is "pinched" by the bone? Ice may help to decrease the inflammation from arthritic bones and pain signals to the brain. It doesn't hurt to try both out and see which one works better. If one is making the symptoms worse, stop doing it! Always a general rule of thumb: Don't do it if it hurts or makes your symptoms worse. This may also be a great time to reach out to your medical provider for some direction.

Final Thoughts: You Know Yourself Best

Sometimes people say that they really can't tolerate one or the other. I say, that's okay! Do what works for you! You know your body better than anyone; you live in it all day, every day!