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Hey Doc! Should I Use Heat or Ice?

I get this question too many times a day to even count. So, I thought I would spend some time laying out why I might recommend heat for one person and ice for another.


Both heat and ice are helpful tools in pain management. Although there are many theories as to why they work, the research is incomplete and there is still much that is unknown. One main theory for icing, for example, is that the reduction in temperature reduces the conductive ability of your nerve to relay information back and forth, therefore not allowing the ‘alarm signal’ of pain to be expressed as quickly. It is also understood to be helpful for inflammation as blood flow to the area is decreased. Heat, on the other hand, promotes blood flow to the area, which is helpful for healing. Heat activates certain neurotransmitters which blocks the ability for our body to perceive pain.



  1. You have an acute injury (e.g. ankle sprain), within the first 48 hours
  2. Inflammatory conditions (e.g. rheumatoid arthritis, ankylosing spondylitis)
  3. Red, hot, swollen tissue




  1. Acute low back or neck pain
  2. Chronic pain
  3. Muscle stiffness



  • Make sure the ice is covered or wrapped in a wet cloth, and not against your bare skin to protect from frostbite (I’ve done this before. It’s not fun – I promise!)
  • Use the 20:20:20 rule – 20 minutes on, 20 minutes off, 20 minutes on. This can be repeated several times a day



  • If you have sensory issues, be careful not to burn your skin
  • Heat can be applied much longer than ice and there’s really no guideline – just make sure you are awake and aware of the sensations you are feeling so as not to become injured



Having said all that, each person and each body is different; what works for one person might not work for someone else. So, if you love ice and find it’s super helpful for your chronic pain – GO FOR IT!


As with everything, there are precautions and contraindications to all forms of therapy. Make sure you speak with a regulated health care professional to make sure that ice and/or heat is safe for you before using it.


Come see us at Lawrence Park Health Clinic to have any questions answered and to let us help you get out of pain and back to the activities you love doing!


Author: Dr. Allie Dennis, B.Sc. Kin (Hons.), D.C., Acu, CSEP-CPT, SFMA

Toronto Chiropractor | Acupuncture Provider | Personal Trainer | SFMA Practitioner




Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British Journal of Sports Medicine. 2007;41(6):365-369. doi:10.1136/bjsm.2006.031237.

Nadler SF, Weingand K, Kruse RJ. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician. 2004;7:395-9.

Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2015; Early Online: 1-9.


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