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When to use ICE or HEAT

We are frequently asked when to use heat and when to use ice.  The basic rule is to use ice for recent injuries with swelling or inflammation and to use either heat or ice for chronic injuries.

What is Hydrotherapy?

The use of hot or cold water for therapeutic effects is hydrotherapy.  Moist heat is used to enhance relaxation, treat chronic injuries and pain, and to help prepare for an activity.  Ice is used to decrease swelling, relieve pain, and treat injuries.  The most common question we get is when to use heat and ice, so we have provided some guidelines below to help you make your decision to use heat or ice at home.  If you do use heat or ice always monitor the area under the heat or ice pack to make sure it does not get too hot or cold.  Do not lay directly on heat or ice.

Stop use of hot or cold if any of the following occurs:
  • Dizziness
  • Headaches
  • Heart Palpitations
  • Hyperventilation
  • Fainting
  • Skin Sensitivity or irritation
  • Shivering
  • Nausea
  • Excessive redness in the area being treated
  • Cramping both in the area being treated and/or other areas of the body during treatment


Do not use hydrotherapy if you have any of the following conditions:
  • Over open wounds or rashes
  • If you have malignancy, lymphedema or undiagnosed conditions
  • If there is a possibility of internal hemorrhage
  • Areas with decreased circulation or numbness
  • Use caution during pregnancy: localized application is okay, but do not do full body immersion or apply heat or ice to the abdominal region

Ice: Cryotherapy

Cryotherapy is the application of ice to any part of the body for a therapeutic affect.  Ice can be applied to an injured or painful area or injury at any time.  It is especially helpful when there is swelling or inflammation.  Ice is usually applied for about 10-15 minutes every 2 hours depending on the area of the body (longer duration for areas with lots of tissue such as hips, back, and legs.  Shorter duration for bonier areas such as wrists, ankles, and fingers).  When you first apply the ice pack it will probably be uncomfortable and cold.  After a few minutes you will feel a tingly burning sensation.  Keep the ice pack on until the skin under the pack is numb to the touch.  This usually takes about 10-15 minutes depending on the area.  

When to use:
  • As soon as possible after an injury
  • If there is any swelling, inflammation, and/or heat at an injury site
  • Painful areas and injuries
  • After surgery
  • For the first 3-5 days after any kind of acute injury such as a sprain, strain, pulled muscle, post surgery, or any type of swelling
  • For 10-15 minutes every 2 hours at least 3 times per day (i.e. when you wake up in the morning, at lunch time, at night before bed)
  • On areas of chronic pain or injuries directly after an activity.  Do not use ice before the activity
Benefits:
  • Facilitates healing
  • Decreases inflammation
  • Helps prevent further damage after an injury
  • Decreases muscle spasm and relieves tense muscles
  • Decreases pain
  • Causes vaso-constriction which limits blood flow and decreases pain
  • Offers localized analgesic affect by numbing the tissue
  • Interrupts the pain cycle (Gate Control Theory of Pain)
Do not use if you have the following conditions:
  • Areas without feeling or sensation (i.e. neuropathy, numbness)
  • Areas with previous frostbite
  • If you have hypersensitivity to cold such as Reynaud's syndrome or Lupus
  • Use caution if you have uncontrolled blood pressure and/or circulation issues
What to use
Always put a thin barrier between the ice pack and your skin
  • Our favorite: Gel ice pack in a pillow case
  • Ziploc bag filled with ice in a pillow case
  • Frozen vegetables are best when eaten rather than used as an ice pack because they do not hold cold for very long and are not the best type of ice pack...and after successive thawing and freezing they do go bad.
  • Disposable baby diaper soaked in water and frozen: although this may sound strange, it works very well when you have access to diapers!
Use of Ice During Massage:
  • Ice packs: We might use ice packs on an area of your body if there is any inflammation or swelling or after we work on a specific area.  We will put an ice pack on for 8-15 minutes depending on the area.
  • Ice massage: ice massage is done by a massage therapist with ice directly on your skin for 3-5 minutes.  We use circular motions with a small piece of ice over a specific painful area.  This is often done over a muscle or tendon that we have done concentrated work on.
  • Immersion: this is done by placing an extremity such as a hand or foot in a bucket of ice water for 3-10 minutes to help decrease inflammation or swelling.

Heat: Thermotherapy

The application of heat to a specific area of the body is called thermotherapy.  You can apply heat for 15-20 minutes depending on the area being heated.   Moist heat is best because it penetrates farther into the tissue.  Remove the heat if pain is increased, you start to overheat, and/or there is any cramping.  Do not use heat if there is any inflammation!  Don’t lie directly on the heat source.  Always remember to drink lots of water because heat can be dehydrating.

When to use:
  • Heat works best on chronic injuries and repetitive stress injuries as long as there is no inflammation
  • Planter Fasciitis:  Use heat on feet before walking or getting out of bed.  It helps to warm up the tissue and decreases pain.
  • Use heat on an area of chronic pain or injury before an activity to help prepare the tissues for activity.  
  • Use on stiff tight muscles
Benefits:
  • Facilitates healing (after swelling is gone)
  • Increases relaxation
  • Can decrease pain
  • Increases blood flow
  • Decreases muscle tension and spasm
  • Helps to soften and spread fascia so that there is more room for the muscles to move and relax
  • Decreases joint stiffness, which can help with range of motion
  • increases lymph flow
Do not use if you have the following conditions:
  • Areas without feeling or sensation (i.e. neuropathy, numbness)
  • Areas with swelling or inflammation: heat can increase swelling and inflammation, which can lead to more pain and increased healing time
  • Open wounds/rashes
  • Fever: can increase overall body temperature so do not use if you have a fever
  • Infection: do not use over areas with infection as it can increase and spread the infection
  • While sleeping
  • Severe arterio or artherosclerosis
  • Uncontrolled hypertension/high blood pressure
  • Thrombophlebitis
  • History of Hemorrhage
What to use:
Always use a barrier between the heat source and the skin
  • Hydrocollator packs: moist heat
  • Heating pad: dry heat
  • Thermophore: moist heat
  • Wet towels heated in the microwave
  • Hot water bottle
  • Whirlpools/hot tub
  • Steam/Dry Sauna
  • Hot bath
Use of Heat during Massage:
  • We may use heat during your massage to help relax your muscles for deeper work and for overall feeling of relaxation
  • Hydrocollator packs: These are clay filled packs heated in a hydrocollator filled with water.  Always let us know if you get too hot!
  • Hot Stone Massage: This is the use of heated stones during a massage to provide an overall feeling of relaxation.  Stones are placed on the body and used for massage.  This is something we are planning on offering in the future.
  • If you want to add heat to your massage ask us!

Contrast Therapy

Contrast therapy is alternating heat and ice over tissue for a therapeutic affect.  Heat acts as a vasodilator, which expands the capillaries and brings nutrient rich blood to the surface area.  Ice is a vasoconstrictor, which contracts the capillaries and sends the blood towards the body’s core.  Contrast therapy alternates expansion and contraction of the capillaries, which acts as a vascular pump/flush to help reduce edema and swelling.  Contrast therapy also interrupts the pain cycle by distracting the brain receiving pain messages through contrasting hot and cold.

How to do contrast therapy
  • Alternately apply heat and ice: heat for 2 minutes then ice for 2 minutes for 10-20 minutes.Always begin and end with ice!
When to use:
  • A few days to a week after an injury when swelling has decreased and there is no heat or inflammation in the injury site.
Benefits:
  • Reduces edema
  • Flushes injury site and improves drainage of waste products
  • Feels good
  • Reduces pain
  • Increases circulation in tight muscles
  • Increases oxygen supply to soft tissue
When not to use:
  • Do not use in the first few days after an injury
  • Do not use when there is excessive swelling
  • The contraindications are the same as heat and ice
What to use:
  • Same as heat and ice
Use of Contrast Therapy During a Massage
  • We may use alternating ice gel packs and hydroculator packs during a massage to assist in flushing an injury.