My patients come to me with a wide variety of questions, looking for guidance and answers. Many times the answers are not cut and dry. There is a lot of gray area and many variables at play. Why is my pain in my left shoulder when I am right handed? When exactly will I be able to run again? What exactly is causing this pain in my back? There are answers to all of these questions, just not one answer. While there is not just one answer to the question of when to use ice and when to use heat, there are rules to follow to lead you to the correct answer. First, let’s talk about what happens when you injure yourself. When a tissue is newly injured or irritated, there will be localized swelling to the area of injury. The body responds by increasing blood flow to bring healing cells to the area of injury. While those healing cells are important, the increase in blood flow can compound the swelling from the injury. When there is swelling (visible or not), this swelling will actually slow down the recovery process. Increasing the blood flow on top of the swelling from tissue injury will even further slow the recovery process and likely increase pain.

Now, let’s talk about what ice and heat do when applied to your body. When ice is applied externally to your skin, it lowers the temperature of the tissues below the skin. This causes restriction of blood flow and the tissues to tighten up. If you apply a heating pad to your skin, this will raise the temperature of the tissues below the skin. This will increase blood flow. When blood flow is increased, the tissues will relax.

When to Use Ice

If you are experiencing pain and/or swelling from a new injury and soreness/irritation from a change in activity or exercise, apply ice to reduce your pain and swelling and to facilitate the healing process.

When to Use Heat

If you are experiencing a chronic pain, particularly in your back or neck, and feel muscle tightness or spasms, use a heating pad.

If you are unsure, try ice first. When applying heat or ice:

• do not apply directly to your skin.
• Use a pillow case or thin towel as a barrier to protect your skin from damage.
• Apply for 10-15 minutes at a time.
• If you have any concerns or questions, please first contact your physical therapist or your physician.

Marie Boneparth

Marie Boneparth completed her Doctor of Physical Therapy in 2004 from Virginia Commonwealth University. She began her career at a large teaching hospital and has spent the majority of her time working in orthopedics with a very diverse patient population. Marie became a board certified Orthopedic Clinical Specialist in 2013. She values the importance of professional development and continued learning so that she is best able to help her clients. Marie loves to work with clients on shoulder pain and injuries, knee pain and injuries, foot and ankle pain, spine pain, as well as improving balance and safety, post-operative rehabilitation, and return to sport.Outside of work, Marie is busy with her young daughter and enjoys cycling, snowshoeing, hiking, swimming, and travel. She looks forward to getting her clients back to doing the things they love!

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