ONCE AND FOR ALL, SHOULD I USE HEAT OR ICE??

Many patients and clients have asked me whether they should use heat or ice on an injured or sore body part.  There seems to be many opinions about this.  What has worked for me in the past and what I tell my patients/clients is this:
1.  If it is an acute injury, meaning it is days/weeks old such as surgery, ice is the only option.
2.  If it is subacute or chronic, meaning it is months old, heat may be used.
Reasoning: After initial injury, inflammatory agents rush to the injured site.  To minimize swelling/edema, ice is applied.  Ice may be applied from session to session.  However, after a few weeks or even months swelling may continue to be present.  At this point, heat, specifically moist heat may be applied.  The heat will increase blood flow to the recovering site notonly bringing healing agents to the area, but actually "flushing" the remaining inflammatory agents and swelling out of the region.
Exceptions: 
1.  Some overuse injuries such as shoulder impingement, tendinitis, etc... may be a chronic condition, meaning it began months ago.  However, continued use of the body part may cause consistent pain due to aggravation and further inflammation.  Meaning, you never leave the Acute stage and should continue to use ice, particularly after a workout when it is most aggravated.
2.  Being that I live in Florida, I have only had a handful of patients who do not mind ice.  Those who do not like ice actually tense up their entire body when it is applied.  With these clients, you are better off not even using either modality if they are in the acute stage.  The tension caused by applying the ice can actually cause more pain for the patient.

Here is a economical way of making your own ice pack:
Fill a freezer ziplock with 3 cups water and 1 cup rubbing alcohol.  Make sure most of the air is out of the ziplock before freezing it.  Seal it and freeze it overnight.  It will freeze into a gel-like substance and so conforms to whatever body part you apply it to.

Hope this helps.  Good Luck