The Great Debate: Heat vs. Ice

Written By Dr. Jesse J. Suess, DC

Heat and Ice are two of the most commonly used home-therapies for musculoskeletal type pain and injury. Most people attack this therapeutic decision as a matter of preference, and that could be one of the most detrimental mistakes to the rehabilitative process. Just as it is with any other means of treatment, heat and ice both have treatment guidelines that should be followed. The goal of this article is to help you have a deeper understanding of the therapeutic effects of both heat and ice, how each affects the inflammatory process, and when it is a good time to reach for the heating pad vs. when you should crack the freezer and pull out the ice pack. Now remember, as it is with every one of my articles, this article is strictly meant for educational purposes. If you are experiencing pain, swelling, discomfort, or anything similar; I strongly recommend that you seek the opinion of a healthcare professional.


Cryotherapy (Ice-Therapy) vs. Heat Therapy

The key to debunking this debate lies in how each of these therapies affects the body’s inflammatory response. If you can understand the basics to the body’s inflammatory response, it will be easy to understand when you should use heat vs. when you use ice. 

Cryotherapy (Ice-Therapy)

Therapeutic Effect:

Ice is probably the safer of the two options. What Ice does therapeutically is constrict the blood vessels and controls the amount of blood flow to the area of complaint. Ice also slows the cell’s metabolic process, which in turn halts the inflammatory response all together. 

When to Use:

The rule of thumb that we tell our patients is “whenever you have done something to put stress on the area, heir on the side of ice”. The reasoning behind this is because any stress to an area of injury triggers the body’s inflammatory response and causes fluid to build-up in the area, what we know as “swelling”. Now what are some things that put stress/strain on an area? It doesn’t have to necessarily be an “active” activity. Things like long periods of sitting, working on a computer, long periods of standing, etc. all put stress and strain on the spine.  

Heat Therapy

Therapeutic Effect: 

Heat-therapy seems to be the more popular of the two choices because of its immediate palliative effects on the area of complaint. The problem with heat is exactly that, heat feels great while it is on you. What we need to know about heat is that, although it feels great, heat draws blood to the area of application. This can be a big problem for an area of injury that is already dealing with a degree of swelling. Heat can create a viscous cycle that plays out something like this. Patient is in pain so he/she applies a heating pack and experiences immediate relief. Fluid is then drawn to the area, and 20 minutes to 1 hour later the patient is agony because of the excess swelling generated by the heat, so he/she reaches back for the heating pack in attempt to gain relief and in turn continues to fuel the fire that is the inflammatory process. 

When to Use:

Heat can be very effective means of therapy if used correctly. As mentioned above, we want to avoid heat if we have any amount of swelling in the area or if we have done anything to put stress/strain on the area of complaint (anything active, long periods of sitting or standing, driving, etc.). Heat can be very effective in chronic situations. When a chronic presentation presents the involved muscles are usually stuck in the contracted, or shortened, position which decreases the amount of blood flow that has access to the muscle. The lack of blood-flow to chronically contracted muscles means that the tissue isn’t able to dispose of waste properly which leads to a build-up of lactic acid. Applying heat to a chronically tight muscle will draw fluid to the affected area which is beneficial in the way that it will supply the muscle with the proper nutrition that it is lacking in a chronically tight environment.  A good time to lean for the heating pack is in the morning after waking up when the muscles tend to be tight, or BEFORE exercising to help initiate blood flow to the muscles that are to be activated, just remember to apply ICE AFTER exercising, and to do an adequate amount of stretching before and after exercising.


Jesse J. Suess, DC
Suess Family Chiropractic, LLC
22 Wyckoff Ave., Suite 1

Waldwick, NJ 07463