Have you ever gone to a doctor and been told to put ice on the inflamed area? Have you ever gone to another doctor who instructed you to do the exact opposite and put heat on instead. This has been a huge conundrum in the medical field for several decades. Many doctors argue that ice is better, whereas others will say heat is better. This week’s blog will help make things clearer as to when ice is appropriate and when heat should be applied instead.

When Should Ice Be Applied?

Let’s look inside the human body to understand exactly what is happening when ice is applied to an inflamed area. When ice is applied, blood vessels vasoconstrict, which prevents a large quantity of blood flow rushing into the area. This is the response that we are looking for because it focuses on the inflammation that is present in the area. 

Ice should be applied in cases such as acute conditions, inflammatory conditions, areas of swelling and redness, arthritis, migraines, and small falls/injuries caused by sports, auto/work accidents, or surgery.

When Should Heat Be Applied?

When people collide and fight, it’s typically because they have opposing perspectives, right? Ice versus heat modalities work the same way. Therefore, ice produces the opposite effect of ice within the body. When heat is applied, it causes blood vessels to vasodilate which allows more blood flow to be present in the area.

Heat should be applied in cases such as chronic conditions, non-inflammatory conditions, osteoarthritis, tension headaches, muscle spasms and injuries caused by sports, auto/work accidents, or surgery with a prolonged recovery time.

Why is it Important to Know Which Modality to Use?

It is important to know when to apply ice and when to apply heat, but how do you know when to apply which modality? The biggest determinant is whether or not inflammation is present. Any doctor should know if someone is showing signs of inflammation or not. That is why taking a detailed patient case history is important. It allows the doctor to know what type of condition they are dealing with, how long the patient has been suffering, and what needs to be done to get the patient better. Therefore, if inflammation is present, apply ice. If inflammation is not present, apply heat.

Instructions For Applying Ice or Heat

Whether ice is applied, or heat is applied, they both have the same instructions on how to apply, where to apply, and when to remove it from the treated area. 

  • Step 1: Wrap a few layers of a towel over the pack being used to prevent frostbite/burns from occurring.
  • Step 2: Apply modality to the area being treated for approximately 20 minutes for best treatment outcomes.
  • Step 3: Remove modality from the treated area for at least 40 minutes.
  • Step 4: Re-apply modality to the treated area and continue with intervals of 20 minutes on and 40 minutes off.
    • NOTE: Refrain from applying modality to area if you are sleepy to prevent any frostbite or burns. If you do so, be sure to put a timer on or let a significant other set a reminder to remove the modality after 20 minutes.
    • NOTE: This is the most important thing to remember. Applying either modality for longer than the recommended time does not speed up the recovery process. In fact, it will prolong the recovery process because the body is not used to ice or heat being applied. The body will begin to recognize either as harmful and will naturally stimulate hormones to bring inflammation to the affected area.  

What Do We Recommend?

Every doctor has a different opinion on this topic. 95% of our patients arrive in an acute state so we typically give instructions to use ice. We usually tell the other 5% to apply ice first too because even though they’re in a chronic state, there is still some inflammation in the area causing pain. Spinal manipulation stimulates a cytokine response that helps fight off inflammation. In the beginning of treatment, the body may feel like it’s in a war because the nervous system is fighting the inflammation. Therefore, ice is always best at the beginning of treatment.

We hope that the information we provided has given you a clearer idea of when to use ice and when to use heat. It has been a controversial debate between medical professions for decades and will continue to do so for many more years. If you have any questions about ice and heat application, please call us at (724) 547-3377 and checkout our website at for more information. 

Yours In Health,

Larry E. Wilkins, DC

Brian M. Steinert, DC