Ice vs. Heat: The difference and why


If you are like me, one of the most unappealing and border line offensive things that could happen is to come into contact with a sub 32°F surface. So if I am already in pain/discomfort and you ask me to throw an ice pack the size of a throw pillow on my back, you will get stank eye. However, in most cases it is/will be the cheapest and one of the most therapeutic things you can do. Nine times out of ten I tell my patients to use ice over heat. Most pain is related to a source of inflammation. During the inflammatory process your vessels dilate (widen) which allows for more fluid to come into an area creating more pressure. That with the types of cells accompanying the extra fluid creates a sensation that your brain interprets as pain [insert chapter from your nearest pathophysiology book for a deeper explanation]. So how do we combat this widening of vessels? With constriction! Ice is a vasoconstrictor so by applying ice to the area of pain, the vessels will constrict, clearing excess fluid buildup from the area, creating less pressure, and less sensation for your brain to interpret as pain. On the other hand if you are a reader that is convinced ice is not therapeutic because of some recent studies (not a jab, just saying) then there is always the benefit of ice “distracting you” from the pain the same way any other neuromodulation modality would. As far as “how long do I leave the throw pillow of death on” is concerned, ice for 8-15 minutes is appropriate. Hack: if you don’t have an ice pack and you don’t want to spend money on one, grab a freezer gallon bag and fill it half with ice and half with water. The water makes the pack more malleable and easier to rest on a body part. Make sure the bag as multiple strips to seal or you’ll be unpleasantly surprised by an ice cold drip shortly.


Heat is magical and wonderful and if the water temperature in the shower does not leave you as red as a tomato is it even worth showering? No? That’s just me? Anyway, heat can be therapeutic,but is not indicated if your pain/discomfort is related to an inflammatory process. If you have had a long day of hard labor (gardening, job related, weekend warrior muddy glad you didn’t tear your meniscus obstacle course 5k, etc.)  and you feel general stiffness, warm up the bath water or the hot shower because heat is right you. To add a little bonus relaxation to that hot bath, throw in at least 1 cup of Epsom salt for a waist high bath and soak for at least 20 minutes. The magnesium sulfate in the Epsom salt will help relax the muscles more. Transdermal application of magnesium sulfate works faster and in some cases better than ingesting it orally (MgSO4 capsules that is, don’t ingest the Epsom salt). Thank you, Queen Wardlaw for that tip. In fact if you want a great read for understanding your pain and how diet and other factors can contribute/regulate it check out Cheryl’s writings here.

Take Away

Neither ice nor heat will cure you. They are both just modalities you can use to modulate your pain or what your brain perceives as pain. Heat may feel better, but if your pain is inflammatory in nature, adding heat to it will just increase your discomfort. In the moment it will feel nice, but give it a few hours and you will be regretting the choice. If you are going more than a few days with pain that is not easily alleviated or you have a recurring pain, get checked out by a trusted physical therapist. Don’t know of a physical therapist in your area? Check out this link to find a Certified Functional Manual Therapist closest to you. CFMTs are physical therapists that have gone through rigorous studying and testing to earn a post-grad certification that ensures quality.

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