Hot and cold therapy? Ice? or Heat?

Hot and cold therapy vs cold and hot therapy?!

Firstly I would like to clarify one major point and that is the massive misconception of the phrase hot and cold therapy. During this post I will be referring to the treatment as hot and cold therapy as that is what it is most commonly known as, however this does imply that heat should go on first and then cold second. FALSE!

The correct way round is Ice first and Heat later! If you do hot and cold therapy they will just cancel each other out and I will explain why later on in the post. First I want to discuss how ice and heat work separately and on what types of injuries they are individually useful for.


Ice is extremely useful for acute injuries where excess inflammation/swelling is present. Now I will just make a point that there seems today to be a lot of demonisation about the word ‘INFLAMMATION’ as if it is this nasty thing the body produces intended to mess you up and make you swell up like a balloon following an injury, this again is a general misunderstanding as the inflammatory process is the body’s way of healing itself (I will do another post about the details of this process but for now just trust me).

However sometimes the body provides too much inflammation to the affected area. Ice will not get rid of inflammation, instead it constricts the blood vessels to the area which decreases the amount of inflammation present, therefore the inflammation already there can get on and heal the affected area without extra swelling causing pain. Ice should always be wrapped in a protective covering i.e. a thin tea towel (believe me you do not want an ice burn!) and applied for no longer than 20 minutes at a time (10-15 is usually sufficient).


Heat treatment can be very useful for more chronic injuries including joint stiffness and muscle spasms. The heat as you may have guessed will do the opposite to the ice and dilates the blood vessels thus allowing inflammation and nutrients into the affected area. It will also help to relax tight muscles. You don’t have to be as regimented with heat as you do with the ice but again a general rule of 20 mins max application is good to adhere to. As with the ice use a protective layer on it so as not to burn the skin and remmeber that the heat should feel nice, if you experience any discomfort then it is either too hot or the injury is getting too much inflammation/swelling and in that case remove it and apply an ice pack instead.

Hot and cold therapy (really cold and hot therapy!)

Now it seems like I am contradicting myself when I say that heat and then ice doesn’t work when ice then heat does. Basically the reasoning behind this is that with an injury for example a Frozen shoulder where swelling is present but there is also a lot of restriction you can use this treatment. As mentioned above the ice will take down the inflammation and reduce pain, however it will tighten up the muscle tissue, ligaments and joint capsules. You then apply the heat which will help relax these structures and will also bring fresh inflammation to the area but because it was lowered significantly by the ice it wont generally go up as far as to cause swelling and become about the right amount that is optimal for healing. If you do the reverse i.e. heat before icing then all you do is increase the already high amount of inflammation present and then immediately restrict the tissues that have been relaxed through heating therefore cancelling each-other out and may even cause further damage.

Anyway as a picture is worth a thousand words here’s a graph: Hot and cold therapy

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Peter Heale Chiropractor in Hitchin and LutonFrom the team at Heale's Chiropractic Clinics
Over 30 years of helping people in Hitchin and Luton and the surrounding areas of Hertfordshire and Bedfordshire

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