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Guidelines - Hot or Cold

As a physical therapist, patients often ask about home management of injuries or pain and most often it is pertaining to the use of heat and/or ice for a particular condition.  In general, injuries or conditions can be classified into categories based on timeframe including acute, sub-acute and chronic conditions and timeframe of the injury will determine the most effective treatments.  These timeframes may vary depending on the source however in general are as follows: 

Acute Condition--7-10 days

Sub-Acute Condition--10 days to 7 weeks

Chronic Condition--greater than 7 weeks

Indications of Heat:

  • Reduce pain
  • Reduce muscle spasm

Indications of Cold:

  • Reduce local inflammatory reaction
  • Reduce muscle spasm
  • Reduce pain

Take, for example, a newly sprained ankle (acute) that is usually associated with pain, swelling, bruising and limited ability to bear weight through the extremity.  Heat will cause an influx of fluid to the area increasing swelling, while ice will reduce blood flow to the area.  In the case of the ACUTELY sprained ankle, ICE would be the optimal choice to reduce pain and reduce swelling (if swelling is severe, blood flow may be impeded and can be problematic for the patient).  Swelling can also be reduced by elevating the involved limb above the level of the heart.

In the case of the CHRONIC pain scenario such as low back pain, the concern of increased swelling is generally not present.  Associated with chronic low back pain are general complaints of stiffness, soreness, muscular tenderness and reduced mobility.  In this case, the goals would be to increase blood flow to reduce muscle tenderness/tightness and reduce pain, which can be achieved by applying HEAT to the affected area.

The sub-acute injury is a little more challenging to determine the correct application and should be based on the presentation of the injury and the goals of the application.  In the case of continued swelling, tenderness and pain, ice may be a better choice.  However, if the goals of the application are to reduce muscular tension, pain and tightness, heat may be a better choice.  

Always consider the goals of the application prior to making a decision.  In general, for the acute condition ice should be applied to reduce swelling and pain.  In the case of the chronic condition, heat is the most helpful application.  In all cases, injuries should be evaluated by the most appropriate medical professional in order to determine the present condition and to develop the most effective treatments.

Stephen DiGiambattista is a Physical Therapist at North Pocono ProCare Physical Therapy in Moscow.  If there are questions, concerns or you would like to suggest topics for future columns, please feel free to contact Dr. DiGiambattista at

Promoting Healthy Lifestyles, Injuries, General Health, Treatments, Athletic Training


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