Dr. Allan Horowitz, published newspaper article, The Toronto Star, Copyright May 22, 1989

Ice or heat? You’ve probably been faced with that question at some time-likely after a particularly vigorous aerobics class, or sprained ankle, or on a rainy, cool day when every bone in your body seems to ache. Your grandmother always told you to put heat on your sore joints and muscles. But you see athletes on television applying ice to their sore spots. You remember that your doctor once told you to put ice on your sprained ankle, but you also remember that he told you to apply heat to your sore back. Which one of these ancient remedies should you use, and when should you use it?

The physiological basis for applying heat or cold to a painful, stiff or injured area is to alter the blood flow to that area in some beneficial way. Heat will act as a vasodilator, meaning it will open up the diameter of the blood vessels, allowing more blood to pass through the area. Ice will act as a vasoconstrictor, temporarily shrinking the blood vessels and thereby decreasing the amount of blood flow. Ice also helps to block pain messages from reaching the brain, so it has an anesthetic effect on the area.

A sprained ankle, for example, will swell rapidly and might remain swollen for a long period of time if the ankle is not elevated and rested. Constriction of the blood vessel by means of ice applications will result in decreased blood flow to the ankle and therefore a decreased inflammatory response.

By contrast, if you have painful fingers whenever the weather is cold or damp, or when you have over used them, it is likely that he finger muscles and ligaments are tight and ischemic, which means they don’t have enough blood. In this case, moist heat (a hot bath, shower or hot towels, for example) will help to increase the amount of local blood flow. This will not only make the fingers feel better, but will also “loosen” them and increase their range of motion.

When something is swollen because of a recent injury, and it hurts to move that area, ice will usually help. When something has been sore for a long time, or has a stiff, achy feeling to it, moist heat will usually do the trick. Just to confuse the issue, many experts suggest alternating between moist heat and ice, usually for 10-20 minutes each. This technique serves to “pump” the blood vessel to decrease swelling and increase circulation at the same time.

My recommendation is to try either ice or heat as your newfound knowledge directs. If that doesn’t help quickly, try the “pumping” technique.

  • Sore shoulder after a baseball game- ice.
  • Stiff shoulder before a game-heat.
  • Sore knee after jogging- ice.
  • Sore back after lifting- ice.
  • Sore back every time you sit for a long car ride- heat
  • Arthritic hands- heat.
  • Sprained ankle- ice.
  • Sprained ankle from 20 years ago that still acts up once in awhile- heat.
  • Stiff neck (from sleeping in a funny position)- heat
  • Stiff neck (from turning too suddenly)- ice
  • Recent whiplash injury-ice
  • When In doubt: ice-heat-ice-heat.