Ice or Heat: Body Pain’s Greatest Question

Life has a funny way of leaving its mark on us and quite often it can hurt! By now you’ve likely experienced some kind of injury that caused bruising, swelling, and worst of all pain, either acute or chronic. With any injury therein lies the proverbial question, “should I use ice or heat?” The concept of applying these thermal modalities can seem relatively simple and straight forward but it can become confusing as not every injury presents the same. Thus it makes senses why I’m frequently asked which one should be used for a particular injury. Sometimes I’ve suggested that both are appropriate depending on the situation. Improper use of these modalities can slow your recovery, so it is important to base your decision on physiology and what is most safe and effective.

Osteoarthritis is one of the most common orthopedic conditions among physical therapy patients. Osteoarthritis (OA) describes degeneration of cartilage and, eventually, bone in a moving joint. The development of OA can be the result of a previous injury or specific joint condition but is most often idiopathic in nature.1 Knees, hips, and thumbs are notorious for developing OA as a result of the large, repetitive forces these joints have to absorb over the course of a lifetime.2 The term OA refers to a wide spectrum of joint degeneration and can sometimes be used to describe a joint that appears damaged on an X-ray but doesn’t hurt or cause a decline in function (asymptomatic osteoarthritis). Various studies of the general population in the U.S. estimate that 20-28% of adults aged 60+ have evidence of hip OA on an X-ray, yet only 4-10% of this population have pain or poor function due to hip OA.3,4 Although an X-ray may show hip joint degenerative changes, treatment generally does not occur until someone begins to have symptoms.