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Ask an AT – When Do I Use Ice/Heat?

One of the questions I hear the most from my patients in the clinic is “What’s the difference between heat and ice?” or “When should I use ice over heat or vice versa?” The distinction between the two is very important and, although most people prefer to use heat when they are hurt because it “feels good”, it is important to understand the proper applications for each treatment so you can use them effectively and safely.



Indications (When to use it)

Contraindications (When not to use it)


- lowers production in cellular waste
- lowers  inflammation
- lowers pain
- lowers muscle spasm

- acute injury or inflammation (right after it happens)
- acute or chronic pain
- minor first degree burns
- post-surgical pain and swelling
- acute or chronic muscle spasm
- SHARP (Swelling, Heat, Altered function, Redness, Pain)

- cardiac or respiratory involvement
- open wounds
- circulatory insufficiency
- cold allergy
- numb areas
- advanced diabetes


- lowers muscle tone
- lowers muscle spasm
- lowers pain
- edema formation (swelling)
- elasticity of tissues

- chronic inflammation
- chronic pain
-limited range of motion
- chronic muscle spasm

- acute injuries (48-72 hours following injury)
- impaired circulation
-poor temperature regulation
- numb areas

The general rule of thumb that we give our clients is always to use ice over heat. Ice is the only safe option following an acute injury because it will decrease active inflammation as opposed to heat, which will add to it. And ice has the same effects on a chronic injury as heat, so you really can’t go wrong.
With any treatment done at home you need to ensure you are applying it in a proper and safe manner to decrease the chance of side effects such as frostbite or burns. The proper parameters for applying heat and ice are listed below.

Source *

Length of Time

Sensations (What you will feel)


- crushed ice in a bag with the air sucked out
- moldable gel ice pack

- on for 10 to 20 mins
- off until skin returns to normal temp.

- Cold, Burning, Aching, Numb – you must reach the numb phase for ice to be effective


- moist heat packs
- heating pad
- hot water bottle
- microwaveable hot bag

- on for 30 mins
-off until skin returns to normal temp.

- heat

* No matter what source you use for ice or heat you must put a layer between the source and your skin, such as a towel. This will further help to prevent burns or frostbite.
Still unsure of which modality you should be using? Here are a couple of examples of common ailments and what you should use for them:

Example 1: You are walking out of the grocery store and on your way to the car you step on a rock and your ankle twists. The ankle swells up and is red and hot to the touch. Ice or Heat?
-Ice! This is an acute injury and ice or cold will help to decrease inflammation and swelling.

Example 2: Last weekend you helped your neighbor move furniture and 3 days later you have some lingering soreness in your back and shoulder. Ice or Heat?
-Heat! Your pain is probably due to lingering muscle spasm and heat will help to decrease that spasm and relax the tissues. As long as there is no heat, redness or recurring swelling heat is a safe option.

Of course, if you are injured the absolute best thing you can do is contact Alpine and book an appointment with one of our Athletic Therapists for a complete assessment and treatment of your injury!

Ask an AT – What is an Athletic Therapist?
Each month, we will ask our therapists a question related to their field. If you have a question for our Athletic Therapists or Massage Therapists, do not hesitate to email us to

The question many people ask when they’re looking for a new therapist or during their first treatment is “What is an Athletic Therapist” or “What’s the difference between Athletic Therapy and Physiotherapy?” Well ask… and you shall receive.

What is an Athletic Therapist?

Cassie Campbell

Athletic Therapists and Physiotherapists are both trained in the clinical management of injuries, and while there are many similarities in the techniques for both professions there are also some very significant differences. Athletic Therapy employs a very active treatment style; including hands on techniques.

A big component of an Athletic Therapist’s treatment technique is the rehabilitation plan, which is tailored to each patient’s needs. It always includes a number of stretches and exercises that we use to correct imbalances in strength and flexibility, and to stabilize an injured area to prevent and protect from future problems.

By developing a rehabilitation plan for each patient, with stretches and exercises that they can do at home, we enable them to take on a much more active role in their recovery. In the end, an Athletic Therapist’s main goal in treatment is to return their patient to their normal every day activities as quickly, effectively and safely as possible.

Kristin Streed

Athletic Therapists are trained through the full spectrum of an orthopaedic injury. Prevention, urgent care, education, assessment, rehabilitation (specifically third stage/reconditioning stage). We follow a sport medicine model that looks at the injury within the abilities, requirements and goals of the individual. We strive to keep you active throughout your injury and not only get rid of your pain, but to allow you to perform better and without reoccurring injury. Our in-depth assessment skills allow us to determine not only the injury, but the underlying cause of that injury. Your treatment with the athletic therapist should address both the current or secondary injury as well as the cause. Our treatment style tends to be more aggressive and more active. They may incorporate some modalities and other passive treatments, but by far they are active programs. Patients take part in their rehab and therefore recover faster. Because we are equally trained to work in the clinic as well as the field, we have witnessed injuries from their onset, and therefore understand the mechanisms behind them. Knowing and understanding the training regimes and strength/weaknesses of a sport allow us to hone in on the probable causes that much easier, leading to a quicker recovery.

Canadian Athletic Therapist’s Association

The Scope of Practice of a Certified Athletic Therapist includes the prevention, immediate care, and reconditioning of musculoskeletal injuries. Prevention includes musculoskeletal and postural evaluation, equipment selection, fitting and repair, warm-up, conditioning programs, prophylactic or supportive taping, and adapting to the activity environment and facilities.

The provision of on field immediate care of athletic injuries by a Certified Athletic Therapist includes: injury assessment, basic emergency life support, recognition and management of acute traumatic neurological dysfunction, provision of first aid, preparation for entrance into appropriate health care delivery systems, or, where appropriate, utilization of techniques facilitating a safe return to participation.

A Certified Athletic Therapist assesses injuries and conditions, uses contemporary rehabilitative techniques, therapeutic modalities, soft tissue mobilization, physical reconditioning, and supportive strapping procedures to promote an environment conducive to optimal healing in preparing the individual for safe reintegration into an active lifestyle.

The Athletic Therapist, in cooperation with all performance enhancement personnel, and members of the health care delivery team, is an integral part of a total service to maximize the performance and welfare of the individual. Concomitant with the execution of this role, the Athletic Therapist nurtures an attitude of positive health.

Ask an AT – What is the difference between Athletic Therapy and Massage Therapy?

Athletic Therapy uses an orthopaedic assessment, modalities and hands on treatment. Athletic therapists also provide a personalized, activity specific rehabilitation program to get you back to work, sport and life.

Massage Therapy uses manual skills to promote changes soft tissue, circulation, muscle spam and pain.