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Ask the PT: Hot or Cold?

Posted by Scott Rosen on December 2, 2016

I am often asked whether heat or ice is better to use for pain or minor injuries.  Like many answers in the physical therapy world, it depends.

The first 48-72 hours after an injury is known as the acute phase. There will be localized pain, inflammation and possible redness at the injury site. During this time it is appropriate to use ice.  The goal is to reduce pain and swelling.

An ice bag or a frozen bag of vegetables will do the trick. For a home-made ice pack, mix 2-parts water and 1-part alcohol (drinking or rubbing) in a zip-lock baggy and place in freezer overnight. By morning you will have a perfect re-usable slush pack.

Never place ice directly on the skin. This can actually cause an ice-burn. Use a paper towel in between the ice and skin. When the ice no longer feels cold, you can remove. This usually takes 10-15 minutes.

Repeat this process several times a day allowing at least 30 minutes between applications. If symptoms last beyond 2-3 days or with chronic pain it is appropriate to use heat or ice.

The general rule of thumb is “heat before and ice after”. Use a hot pack or take a warm shower to loosen up your joints and muscles before activity. This will increase blood flow to the injured area and help with healing. After activity, or at the end of long day, use ice to help constrict blood vessels in order to reduce pain and inflammation. As always, consult with your physician or physical therapist if symptoms worsen or do not improve.

Scott Rosen, PT, DPT, Clinic Director and Physical Therapist for the new Physical Therapy clinic at the JCC in Squirrel Hill, PT at the JCC Powered by the JAA

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