To Use Heat or Ice, That Is the Question!

We at Rebalance Physical Therapy often get asked, “Should I use heat or ice?” when discussing injury and muscle recovery. This choice is not as simple as you might think.

Cryotherapy (cold therapy) can be achieved with ice packs, ice massage, frozen water bottles, cold compresses, ice baths, and nitrogen chambers (used more recently with athletes). Cold therapy is good at helping to reduce inflammation or swelling which, in turn, decreases pain. Because of this, cryotherapy is often good for acute inflammatory injuries (such as tendonitis), surgeries, joint injuries, or chronic conditions (such as arthritis). Cold therapy also is very good at helping with muscle recovery after exercise or sports participation, especially if the activity is more intense. When building muscle and exercising, small, microscopic tears occur in the muscle fibers and cold therapy helps to heal these faster. A review published in the International Journal of Sports Medicine found cryotherapy reduced muscle pain in 80% of the studies and improved athletic recovery and performance in 71% of the studies. Cold therapy is also useful with nerve pain—it helps to numb the nerve endings and can provide some relief in conditions like migraines, vestibulodynia, and neuropathies.

Thermotherapy (heat therapy) can be achieved with electric heating pads, wet heating pads or hot cloth, infrared heating pads or blankets, hot water bottles, ultrasound, hydrocollator packs, whirlpool baths, and infrared saunas. Heat therapy works best for injuries in muscles and tendons. It works well with chronic injury by helping to increase blood flow to the area for better tissue recovery. Heat works better for relaxation and to stimulate the parasympathetic nervous system, which is our rest and digest nervous system. Heat may also help to loosen tight muscles and increase the elasticity of the muscle fibers and fascia. Heat therapy works well for muscle injuries, sore muscles or fascia, muscle or tendon tightness, and decrease muscle tension throughout the body.

It may also be very appropriate to use both heat and ice and alternating between the two. For example, if you have sore muscles after a hard workout, the ice will help with the recovery of those small little muscle fiber tears and decrease inflammation and pain. The application of heat after ice will then help improve blood flow to the area, bringing in cells to help with recovery and removing waste products that don’t need to be there. This process improves muscle elasticity and flexibility, which helps prevent potential injuries at the next workout.

If you are unsure which one to use, reach out to your physical therapist to see what they suggest. The experienced physical therapists at Rebalance Physical Therapy will assess you and your condition or injury holistically and create a plan for the quickest, safest recovery! Your injury or condition may be better treated with ice, heat, or a combination of both.

Written by Elayne Geba, PT, DPT, WCS




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