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Ice or Heat? Plus! Make Your Own Ice or Hot Packs.

Our patients in our Physical Therapy Program often ask us whether they should use ice or heat for their particular conditions. When deciding on which of these thermal modalities to use, here are some rules and guidelines, which if followed, will reduce the risk of adverse effects or further injury and provide for the most effective way of using these therapies.

Among the many different physiological effects that ice and heat have on a tissue, there are basically 2 that make the most difference. These are vasoconstriction and vasodialation. Simply put, ice results in a narrowing of the local blood vessels (vasoconstriction), while heat will increase the vessels’ diameter (vasodilation). It is because of this main difference that the use of these modalities will vary. While both help to reduce pain, they should be used at the right time and in the correct manner or adverse results may occur.

The general rule is that if the injury is acute (72 hours or less) or if there is inflammation in the tissue, then ice is the treatment of choice. By the same token, if there is no inflammation and if the condition is in a subacute or chronic stage (3 days to several weeks after an injury), then heat may prove to be more beneficial.

When applying ice, one should take caution NOT to apply the ice pack directly to the skin as there would be a risk of frostbite. There should always be one layer of a damp towel or T-shirt placed between the ice pack and the skin.The proper way to use ice therapy is to multiple, back-to-back applications by applying the ice pack for 10-15 minutes (longer than this, and it can have the opposite effect, vasodilation, which would be not ideal), leaving off for one hour, and reapplying it again. Best results are obtained when this is repeated at least 3-4 hours immediately after an injury. To prevent tissue damage, it is important to be sure that the tissue temperature has returned to normal before applying ice to the area again. When using ice therapy you can expect the tissue to feel cold, followed by a burning sensation that will in a short time turn into an ache and will finally begin to feel numb. The main benefit of this will be a reduction in pain, spasm and swelling.

When using heat, once again, prolonged exposure should be avoided. The therapeutic benefit of heat is best achieved by 30 minute applications with an hour in between to allow the tissue temperature to normalize. Heat therapy should never be used in bed as the risk of burns increase if one falls sleep during application resulting in prolonged exposure. The benefit is increased circulation along with reduction of pain and spasm. Since ice reduces blood flow to the tissue, it is important to remember NOT to use ice when a condition has reached a sub-acute or chronic state. This will result in a slowing of the healing process as the tissue is deprived of oxygen and nutrients.

There is a third method of application called “contrast therapy” and it is considered to be superior to using ice or heat alone. This is once again used after the acute inflammation has subsided and its benefit is in its ability to rapidly flush the tissue with blood. Heat will bring in increased blood flow and with it comes increased oxygen and nutrients and ice will cause the blood to rapidly leave the tissue and take the waste and pain producing elements away. This will aid in increasing tissue repair and hence improve speed of recovery. When using contrast therapy, heat is applied first and last and ice is alternated. The time application ratio is usually 3 to one (3 minutes of heat followed immediately with one minute of ice). This should be repeated for approximately 20 minutes and repeated every hour. Following these simple guidelines will help in better outcomes when managing your injuries and will reduce the risk of adverse effects.

Make Your Own Heat and Ice Packs

Homemade gel ice packs

What you need:

1 quart or 1 gallon plastic freezer bags (depending on how large you want the cold pack)

2 cups water1 cup rubbing alcohol (70%)


Fill the plastic freezer bag with 1 cup of rubbing alcohol and 2 cups of water.Try to get as much air out of the freezer bag before sealing it shut.Place the bag and its contents inside a second freezer bag to contain any leakage.Leave the bag in the freezer for at least an hour.When it's ready, place a towel between the gel pack and bare skin to avoid burning the skin.

As an alternative to rubbing alcohol you may simply use dish soap, which has a gel-like consistency and will also freeze/retain the cold.

Another way to apply ice to your painful back is by freezing water in a Styrofoam cup, and then asking someone to rub on the painful area of your back to reduce inflammation.

Homemade moist heat packs

There are two types of heat therapy: dry and moist.

Moist heat packs are less dehydrating to the skin than dry heat. They also allow heat to absorb better into the skin and may relieve pain faster.

What you need:

Cloth container (sock, small pillow case, fabric)

4-6 cups of filling (such as uncooked rice, flaxseed, buckwheat, oatmeal)

Needle and thread (optional, but recommended)


Fill your cloth container with the filling.Tie or sew the container shut.Microwave container for 1-3 minutes.

Follow the use instructions above. Thanks for checking this out. If you are having pain, take the next step and set up a FREE Phone Assessment with one of our Specialists. Follow the link below.


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