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Therapists are frequently asked whether one should be applying ice or heat to an injury. My answer is “it depends”. Here are some simple guidelines to determine if you should be applying ice or heat:

• Acute injuries (occurring in the past 48 hours) should be iced.
• Chronic or longstanding conditions are more complicated since they can fluctuate in and out of an acute phase to dictate whether you should be icing or heating. If you aggravate your chronic condition due to overuse, it should be iced as if it were an acute injury. Otherwise, a heating modality can be beneficial.
• Swelling, Redness, Warmth around the injury site are signs of inflammation and should be iced.
• Stiffness, Tightness without inflammatory signs will benefit from heating modality.

Application of Ice: Use a high quality ice pack that easily moulds to the injury site and wrap it in a damp towel to maximize icing effect. Apply the ice for 15-20 minutes. You can re-apply once the skin returns to normal temperature or an hour between applications. Frozen bag of vegetables or ice-cubes in a re-sealable bag with some water are convenient substitutes.

Application of Heat: Moist heat such as a hot shower, bath or hot tubs are great sources of heat. Alterantively, hot water bottle or heatable gel packs wrapped in a damp towel can be used for 20 minutes. If you frequently require a heating modality, a pricier but convenient option is a quality electric heating pad with an automatic shut off to ensure safety when falling asleep with it.

Precautions: Individuals with conditions affecting skin sensation and circulation should decrease time of application and increase time between applications.

If you are still unsure of which to choose or if the injury persist or worsens, please consult a health care practitioner.

Rob Iwasaki, BScPT, BScKin, Clinical STOTT Pilates, CAFCI, IMS