Ice Therapy

Ice therapy is a common recommendation in treating joint pain. Is ice better then heat? When should I use ice and when should I use heat? Shouldn't I use heat for arthritis symptoms? Knowing the answers to these questions can mean the difference of being in or out of pain.


Step number one in treating any joint pain is to reduce inflammation. Inflammation and swelling are not exactly the same thing. A joint can be inflamed even though there may be no visible signs of swelling. Of course anti-inflammatory medication can be helpful (consult your doctor regarding medication) however there are other non-medication steps you can take.

The typical means of reducing inflammation in an acute injury includes using the R.I.C.E acronym: rest, ice, compression and elevation. Resting can mean crutches for a leg injury or a sling for a arm injury. Compression should be used in an acute situation when visible swelling is present and involves the use of an elastic wrap to help minimize swelling. Elevation also should be utilized when visible swelling is present and requires the area to be raised above the level of the heart to maximize swelling reduction.

ice and sling for shoulder

Heat vs. Ice

One of the most common questions I receive from my physical therapy patients is whether to use heat or ice therapy in reducing inflammation. Often the concept that my patient’s have is that ice therapy is to be used only for the first 48 hours and heat after that. The idea is that ice is only for acute situations and heat for chronic conditions.

Nothing could be further from the truth.

In a huge majority of cases in which a person is still experiencing pain, I recommend ice therapy. Why you might ask? Yes, I know ice is not that comfortable, but there are a number of physiological reasons that ice is the best choice, even after the first 48 hours.

One of the key reasons I recommend ice is the effect it has on our nerves. Have you ever experienced complete numbness after icing a body part? The reason is that ice significantly decreases the nerve impulses that give us sensation……including the sensation of pain. Although the first few minutes can often be very uncomfortable, if you get past them, pain relief will be on the other side. Since pain control is one of the key aspects to joint pain treatment, icing frequently can be very helpful to achieve this goal.

Another key reason ice is so beneficial is how it helps to reduce inflammation. When ice is applied to the body, the body responds by constricting the arteries and reducing the blood flow to the area. After the ice is removed, the body responds by significantly dilating the blood vessels, thus greatly increasing the blood flow to the area. This ‘rebound’ effect in turn assists in flushing the inflammatory cells away from the area, thus providing an anti-inflammatory effect. The dilation that occurs following the removal of ice is much more then the dilation achieved from applying heat, making ice the clear choice.

In addition, because one of the goals of icing is to achieve this ‘rebound’ effect, icing longer is not any more beneficial. For best results, ice only ten to twenty minutes at a time.

Finally, the last reason for the choice of ice therapy over heat has to do with the specific structures that are most often injured. Our skin acts as a wonderful insulator. The application of dry or moist heat packs is simply unable to penetrate our skin and reach the injured tissues. Ice, on the other hand, has the capacity to penetrate beyond our skin and reach the often injured ligaments, muscles, tendons, and joints. The depth of penetration that ice can achieve over heat makes ice again the clear choice.

How to Ice

Because depth of penetration is important, it is important to make sure the tissues get cold enough. The best way to apply ice is to use a freezer grade zip lock bag filled with crushed ice or frozen peas. Then apply the ice pack directly to the skin. If possible, secure it with an elastic bandage to keep it in place. If you cannot stand the cold, use a WET washcloth between your skin and the ice pack.

Although heat can feel soothing, the physiological benefits from ice therapy far outweigh any benefits that can be achieved with heat. For arthritis symptoms, if you are experiencing only stiffness, heat is a fine choice. But, if you are still experiencing pain, ice is the best. Even for chronic conditions ice can yield big benefits.

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