Many people have this question when coming in for therapy - which is better for my injury, specifically - ice or heat? 

The truth is, neither have the research behind them proving that they do much good, longterm. Regardless of whether you ice, your injury will still swell immediately, and regardless of whether you use heat, your chronic pain will return.  Neither are permanent solutions to the underlying problems, but they can, however, be used as short term solutions to help minimize pain. Ice will partially numb a painful area, whereas heat will partially relax the muscles surrounding or leading to pain in a specific area. 

The scientific community still debates on the validity of information reporting that ice and heat will change anything or improve the status of your injury, but heres the deal: it usually doesn't hurt to try.

Below are some simple guidelines, the recommended do's and don't's as far as what injury you  have and whether or not you should ice or heat. Ice is for injuries, and heat is for muscles - in most cases.

Ice is for injuries — calming down damaged superficial tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process … that also happens to be incredibly painful and biologically stubborn. Icing is mostly just a mild, drugless way of dulling the pain of inflammation. Examples would include a recently torn ACL, a knee or ankle that hurts from walking in heels all day, or a rolled/strained joint. 

Heat is for muscles, chronic pain, and stress — taking the edge off the pain of whole muscle spasms and trigger points, or conditions that are often dominated by them, like back pain and neck pain), for soothing the nervous system and the mind (stress and fear are major factors in many chronic pain problems, of course).

What are Ice/Heat NOT for?

Heat can make inflammation worse, and ice can make muscle tension and spasms worse, so they have the potential to do some mild harm when mixed up.

Both ice and heat are pointless or worse when unwanted: icing when you’re already shivering, or heating when you’re already sweating. The brain may interpret an excess of either one as a threat — and when brains think there’s a threat, the pain will likely increase. 

But heat and inflammation are a particularly bad combination. If you add heat to an fresh injury, watch out: it’s likely going to get worse. Pain and swelling will double, as the heat dilates the arteries, increasing blood flow to the area.  As inflammation/swelling occurs as the body's natural defense to protect the injured area, the increase of blood from arterial dilation will therefore, increase swelling. 

If you ice painful muscles, be careful: it might get worse! Ice can aggravate sensations of muscle pain and stiffness, which are often present in low back and neck pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain — the very condition people often try to treat with ice. If in doubt, please see the links below in the “More information” section.

What about an injured muscle?

If you’re supposed to ice injuries, but not muscle pain, what do you with injured muscles (a muscle tear or muscle strain)? That can be a tough call, but ice usually wins — but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury usually involves obvious trauma during intense effort, causing severe pain suddenly. An example would be an achilles tendon rupture in the calf, or a biceps tendon rupture in the arm. In these cases, ice is going to be your best bet.  After surgical repairs or intense therapy in the case of a partial tear, you'll likely continue with ice to help decrease the swelling and numb some of the pain until you're further along in therapy to where the muscle is cramping.  For an achilles tendon rupture and repair, that'll likely be as far as 4-5 months out from the date of the initial injury. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat.

Which is better?

Ice packs and heating pads are not especially powerful medicine: some experiments have shown that both have only mild benefits, but sometimes, any little bit helps.