The age-old question of post-injury care: should I ice it or should I add heat? Unfortunately the answer is: It depends. Lets take a deeper look into the rational for choosing one over the other.

How does ice (cryotherapy) improve pain?

Extreme cold causes our blood vessels to constrict reducing the amount of swelling and inflammation caused by an injury. However, the greatest benefit is seen in the reduction of nerve excitability creating a decreased pain sensation. Cryotherapy, therefore, is most effective during the acute stage of an injury (typically less than 72 hours) when inflammation and pain are highest.


Basic Rules of Ice:

  1. Most effective on acute injuries (<72hours)

  2. Never use ice pack directly on skin

  3. Stop icing if skin turns white

  4. Never put salt in an ice bath


How does heat (thermotherapy) improve pain?

Exciting temperature receptors on the skin creates a sympathetic response causing dilation of local blood vessels. This allows an increase in blood flow to the area in addition to a decrease in muscle tissue tone. Chronic pain from injuries (typically greater than 72 hours from time of injury) may be caused by a combination of excess inflammatory factors and muscle tension. Heat allows new blood flow into the area and a decrease in muscle spasticity, tenderness and spasm.


Basic Rules of Heat:

  1. Most effective on chronic pain or older injuries (>72 hours)

  2. Never heat something giving off heat (sunburn, rash, etc.)

  3. Check area every 5 minutes to avoid unintentional burns

  4. Heat should be relaxing and never hot enough to burn the skin


A good rule of thumb is: If an injury is more than 3 days old use heat, if it’s less than 3 days old use ice.  If an injury causes excessive swelling you may consider alternating ice and heat to create a “pumping” action by the constriction and dilation of blood vessels. Of course your chiropractor can walk you through any questions and provide other treatment options to get you feeling better sooner.