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Choosing Ice For Physical Therapy Complaints

By Beth Jennings, PT

It's hard to imagine a day at FYZICAL - Forest Grove without someone asking, "Do I use heat or ice on this?" The methods, options, and benefits of heat and cold therapy continue to be studied and debated, so it’s ok if you're a bit confused.  

Let’s talk about the most common trends and recommendations. 

When to Use Ice

As first aid: Use within 24-48 hours after an injury like a twisted ankle or a contusion. Have you heard of the acronym RICE? After simple injuries, this standard recommendation is to Rest, apply Ice with Compression, and to Elevate it. Some have changed it to PRICE, adding a P for Protection. 

After surgery, a therapy session, or a workout: Your body may interpret any of these as a new injury, so use ice to decrease irritation.

To reduce muscle spasms or tightness: As with the ankle sprain, apply ice to new muscle spasms to reduce pain, tightness, and tissue irritation. After the initial 48 hours, however, it’s difficult even for us to know whether heat or ice would be better since heat also relaxes muscles. Sometimes trying a session of each and assessing your body’s response is the best choice.

How does the body respond to ice?

When ice is applied to a specific area of the body, blood vessels narrow, and metabolism — or the tissue’s chemical processes — slows. Too much swelling and certain bruising can slow healing, impair function and even cause more pain, so ice is helpful in the early stages after an injury.

The application of ice can help manage pain and reduce muscle spasms and is best used in conjunction with other tools such as compression, medication, and rest after activity. Your physical therapist at FYZICAL-Forest Grove or a healthcare provider can guide you on this.

Be careful, though!

Frostbite and adverse reactions to using a simple ice pack are still possible. Avoid using ice for treatment if you have cold sensitivities (Raynaud's) or a known allergy to cold

Also, avoid ice or other cold therapy over areas of poor circulation or a regenerating nerve.

Avoid prolonged ice where nerves are close to the surface, such as the outside of the knees and back of the elbows. If you are unsure, again, talk with your physical therapist or provider.

Ice Pack Basics

  • A ziplock bag of crushed ice and water is the best inexpensive option. A frozen bag of peas or commercially bought gel packs are good but are not as cold. Combination ice and compression devices are effective but are a pricier option.
  • Apply for 10-20 minutes. Consider the longer end of this range for chilling deeper tissues or if the area has a thicker layer of body fat.
  • Keep a thin layer of fabric between the ice pack and your skin. Wetting the fabric will conduct the cold better. 
  • Compression with elevation reduces existing swelling. Ice mostly prevents it, so combine the three — ice with compression and elevation — if swelling is an issue in a limb. Use an elastic wrap to provide compression. Elevate the limb above the level of the heart. 

Cool Down With Ice

Think of timing when it comes to choosing heat or ice. Heat warms up tissues to prepare for activity, and cold calms them or cools them down after. It's not always that simple, but it's one way to look at it. 

Check for an upcoming blog post on using heat for your physical therapy needs. 

Or give us a call at (503) 357-1706 FYZICAL Therapy & Balance Center - Forest Grove for an appointment.

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Beth Jennings is a freelance writer and physical therapist.


Palmer E. Cryotherapy. Richman S, ed. CINAHL Rehabilitation Guide. January 2020.

Fruth S; Modalities for Therapeutic Intervention, 6th ed, F.A. Davis Company, 2016 (book chapter), Database: Rehabilitation Reference Center