When to “Heat It Up” or “Cool It Down”

Ice vs. Heat Blog

A common question many patients have is when to do ice versus when to do heat. The answer to this really depends on the specific injury. Whether it is the arm, leg, neck or back there is a very simple question that can be answered to help determine how you can help take care of the pain.

The big question is, do you know when you hurt it? Generally, acute injuries have a date or event that caused the injury. This includes things like a motor vehicle accident, sports injury or broken bone. These are events a physical therapist can point to as a cause for the current pain that you are experiencing. For these types of injuries, ice will generally give you the greatest benefit.

For chronic injuries, we are dealing with an injury that has been ongoing for several months or years. These injuries have long surpassed their acute injury process and will now best respond to heating. Heat tends to relax chronic inflamed or aggravated tissue leading to general relief.

Whether it is ice or heat a general rule to follow is to put on the pack for approximately 20 minutes at a time. Twenty minutes is roughly the maximum time frame to achieve therapeutic benefit for your body. After twenty minutes, allow yourself one hour before applying the pack again. You can apply the pack for as many sessions as you would like as long as you are allowing yourself a break  in-between sessions. It’s also a general rule to avoid switching between ice and heat for the same injury.


Defining Acute and Chronic: The following definitions and graphics provide some common instances and references on the difference between acute and chronic injuries for ideal treatment conditions:

ACUTE: Generally sudden onset of pain lasting <6 weeks. Pt may experience some swelling that progresses within hours of initial injury or first notice of pain.

CHRONIC: Generally lasting greater than three month. Mechanism of Injury can be known or unknown. Pain can be minimal to severe with swelling also generally lasting for several weeks at a time.

Sudden, severe pain Sustained Swelling
Sudden onset of swelling Tenderness to a limb
Known injury date/onset Pain of >3 months
Fracture/broken bone Unknown date/time of injury
Sudden back pain or stiffness Low back pain of > 3 months
Pain after exercise Pain before exercise
After surgery Osteoarthritis
Tendinitis Muscle Tension
Muscle Spasms


**These are general statements concerning rules for ice vs. heat. Should you have any questions or require treatment for a condition. Please see your doctor prior to the use of a treatment modality you are not comfortable with using.


Dr. Brittany Wright, DPT, joined the OCH team in 2017. She is available to see patients Monday-Friday at the OCH Evergreen Clinic in Springfield, Missouri. Brittany can provide pediatric and adult physical therapy services. She received her education from Southwest Baptist University in Bolivar, Missouri. To contact the OCH Evergreen Clinic to schedule an appointment with Brittany, call the office at 417-823-2900.

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