The #1 Question in My Office: Ice or Heat?


Oh no! I have a boo boo…Dr. Jen WHICH DO I USE, HEAT OR ICE?

The short answer is: when in doubt, use ICE.  The general rule of thumb is if something is a new, sharp or a different pain, use ice. If it is a nagging, achy stiffness that has been happening on an ongoing basis, use heat.

ICE is the best choice immediately after an injury or when in acute (new!) pain. Ice works to deaden the pain, reduce swelling, inflammation and muscle spasm, diminish tissue damage and speed up the recovery process. Think of an acute injury causing a “fire” of inflammation and swelling in your “boo boo” area and the best way to “put out the flames” is to use ice. Using heat in this time frame can increase swelling and worsen the injury site.

You should start ice application as soon as possible after injury and continue every 3-4 hours for the first 48-72 hours. Crushed ice, ice gel packs or any solid, frozen food will do but remember to always WRAP ICE IN TOWEL before placing on skin. You don’t want to complicate your situation by developing frost bite (blotchy white spots)! For maximum benefit, use ice in 10-15 minute on and off cycles 2-3 times in a row. More does not mean better in this case. The rest time between applications of cold is an important time, allowing blood flow back into the area.

HEAT is only appropriate to use after the swelling has gone down and is especially good for those suffering from chronic pain or stiffness. Never use heat in the first 48-72 hours after an injury. Heat relaxes muscles, prevents muscle spasm, relieves pain and achiness and assists in joint mobility. Applying heat increases the blood flow to an area and therefore speeds the removal of waste products and metabolite buildup from the area.

You can use a gel pack, a heating pad, a hot water bottle, a warm bath or shower. Moist heat penetrates further into the tissue and is therefore always better to use than dry heat. To increase your benefit when using a microwavable gel pack, wrap it in a moist towel. Heat is best used for 15-25 minutes in a relaxed position 2-3 times per day. Do not sleep on a heating pad all night and do not use direct heat in conjunction with a “cream” of any sort. The creams also generate heat and with both, you could burn the tissue.

Again, if you are putting anything directly on the skin, WRAP IN A TOWEL FIRST. Direct heat or cold can cause tissue or nerve damage. If the heat is making any pain worse, discontinue use. Neither heat nor ice should be used if you have a health issue that impairs circulation (such as diabetes).