One of the most common questions we are asked by our patients is whether they should use ice or heat on their area of pain – whether it’s a neck, ankle or low back.   The follow-up question to this is always, How do I know which one to use and when?

First, let’s talk about what ice and heat do with your body. Ice restricts blood flow to the area. This is called vasoconstriction. Heat increases blood flow to the area. This is called vasodilation.

Ice helps to numb the area which can result in a feeling of decreased pain and allow you to move a little more freely.  Ice is great for an acute injury. For example, if you were to roll your ankle and it swelled, using ice would help to decrease the swelling temporarily. With this decreased swelling and numbed pain, you could move the foot around in small circles which would promote fresh blood flow in the area and allow the body’s natural tissue healing process to occur.  There is no need to ice more than 10 minutes. In some areas, of the body, like the outside of the calf, icing too long has been shown to cause nerve damage. It’s best to use ice in 10-minute periods within the first 72 hours after an acute injury, with an hour between each icing session.


  • Ice restricts blood flow to the area and can help with swelling
  • Ice numbs pain
  • Ice should be used for 10 minutes then off for 50 minutes 2-3 times but not directly on the skin
  • C-A-B-N, Cold -Achy-Burning-Numb is the progression of ice, you want to get the area numb before removing the ice
  • Ice is best in the first 72 hours after an acute injury (i.e. rolled ankle) and with aggravations of existing injuries

Heat is best for muscular pain – like a feeling of soreness or muscle cramping.  The warming up of the tissues and the increased blood flow help the tightened muscles to calm. Heat should be used for at least 10 minutes but never more than 20 minutes. Heat should never be used over an area of acute swelling. So, in the previous example, you would not want to heat that swollen ankle in the first 72 hours but after that, a contrast hot-cold therapy of 15 minutes of heat immediately followed by 10 minutes of ice could help to promote fresh blood flow and decrease swelling.


  • Heat increases blood flow to the area
  • Heat can help to relax tight muscles
  • Generally, heat should be used for 15 minutes on then off for 45 minutes 2-3 times
  • Heat is most helpful for sore and tight muscles
  • Heat should not be used over an area of swelling

Many times, the situation is not as clear cut as an acute injury like a rolled ankle or a definite muscle spasm. So, when in doubt, use ice.

Key Points:

  • Ice is best for swelling around a joint
  • Heat is best for muscle soreness and tightness
  • Heat/Ice Contrast is bets for chronic stiffness and muscle tightness
  • If you are unsure if it’s joint or muscle the key thing to remember is: When in doubt, use ice!

By Dr. Chase Waldrup
Chiropractor at Vida Kirkland