When to Use Ice or Heat for Injury & Pain

Whether and when to use ice or heat depends on many variables. It depends on whether you have an injury less or more than 48 hours old. It depends on the joint(s) in question – is it for your back or your knee? It depends on how you typically like or respond to either application. Do you have chronic pain, arthritic pain, or a recently pulled muscle? Mostly it depends on what has worked better for you in the past, especially if we’re talking upper back pain, neck pain or chronic low back pain. It can even depend on the season of year.

Having said that, the Official Rules are: Within the first 48 hours of injury, if there is no bleeding, RICE = Rest, Ice, Compression and Elevation of the body part. After 48 hours, apply heat.

In reality you can choose either after 48 hours.

But what if there is inflammation? Anyway, what is inflammation? I like what WebMD has to say about inflammation:

When inflammation occurs, chemicals from the body’s white blood cells released into the blood or affected tissues to protect your body from foreign substances. This release of chemicals increases the blood flow to the area of injury or infection, and may result in redness and warmth. Some of the chemicals cause a leak of fluid into the tissues, resulting in swelling.

A couple of other things to keep in mind. Arthritic joints tend to prefer heat, especially in the winter. Hands too. I mostly suggest heat for neck pain and lower back pain. But some people prefer cold packs. Go with that.

Chinese medicine most always recommends heat.

In general, knees tend to do better with ice, especially after surgery or a TKR (total knee replacement). But if your joints are aging or arthritic, your knees might like a bit of soothing warmth better, especially in the winter.

In practice, I’ve found that shoulders do well with heat and ice. If the shoulder or arm pain is coming from your neck, you likely have cervical radiculopathy or cervical radiculitis. In this case, heat might be the preferred modality.

I usually ask people for their preferences. Do you usually use ice or heat on your low back pain? What works better for you? Then we take it from there.

You can also alternate ice and heat for short intervals. It’s called contrast therapy.

Except for the 48-hour rule, there’s room to experiment. So we’re back to where we started: the answer is . . . it depends.


Are you getting the best Physical Therapy in NYC?

How to get rock star Physical Therapy when all you’ve been getting is factory made.

How do you know if you are getting great Physical Therapy? Wouldn’t you like your physical therapy to help you heal, feel better AND help you understand your body better at work, home and play? Sharon Gary at Yoga Physical Therapy will give you all of this.

You might not be getting the best Physical Therapy NYC has to offer if your physical therapy looks like the following:

• How much time does your Physical Therapist spend with you one-on-one? Is it only 5 to 15 minutes?

• Is most of your physical therapy time spent with a hot or cold pack, maybe some electrical stimulation for 15-20 minutes, maybe some ultrasound, then maybe a little massage – if you’re lucky?

• After these modalities, are you sent to do your exercises on your own, without supervision or ongoing instruction by your physical therapist? Are you then directed to ride a stationary bike for 10 minutes or some other activity without supervision.

• Does your Physical Therapist just hand you a pre-printed sheet of exercises to do on your own in the clinic or for your home program?

• Does your physical therapist observe you while you do your exercises? Give you adequate instruction? Does your Physical Therapist progress your exercise program, gradually increasing its intensity, as you heal?

• Are your exercises healing? Do they feel good? Do they feel right? Do they feel too hard? Do they hurt?  [Hint: good Physical Therapy is usually NOT painful or super hard.]


• Do you feel confident you are doing your exercises correctly? Does your physical therapist spend time working with you to help you find the inner feel, the inner logic of each exercise?

• Does your physical therapist include the use of a mindful, gentle breath to enhance your exercises’ effectiveness, especially if you have chronic back or neck pain? Does she give you breathing strategies and activities to help you find relaxation inside your own body –  essential tools to empower you to ease your pain?

• Does she work intensively with you, guiding and giving you personalized feedback on how you move and perform each and every exercise, both in the clinic and for your home exercises? Are her instructions clear and easy to follow? Does she take the time to teach you the best way to do the exercises on your body? Help you learn about your body for the long-term? How could you be getting the best physical therapy in NYC if not?

• Does she give you help with your alignment? Does she make sure you are finding ease of movement and not creating more strain?

• Are you getting effective manual treatment to aid the healing process, and to help resolve pain, swelling or inflammation?

• Are you receiving a personalized home program to help you relieve pain between sessions?

• Does your home program help you manage and ease pain and tightness? Does it help you balance and strengthen your connections with your body?

Okay, that’s what great physical therapy does not look like.

So then what does the best physical therapy look like?

The best physical therapy treatments are one hour long, with you and only you in Sharon Gary’s dedicated office space. She sees one patient at a time so she can really listen, see and treat you. Sharon doesn’t run around seeing other patients. She doesn’t use electrical stimulation or ultrasound. Though the machines might feel good, they don’t do a heck of a lot. If you need hot or cold, she will suggest ways to apply it at home.

In Sharon’s opinion and experience there are too many other hands-on, manual treatments which feel better and do better than the machines. Even more importantly, these manual treatments are more effective in helping you heal, feel better, and decrease pain. Sharon might treat you with myofascial release, targeted therapeutic massage, trigger point massage, gentle joint mobilizations to release joint restriction or strain-counterstrain techniques.

For the therapeutic exercise component of treatment, Sharon uses a gentle approach with mindful breathing to soften the body. These exercises are designed to heal, decrease stress and tension, and to empower you to work with managing and decreasing your own pain, especially neck pain, back pain and sciatica.

Surprise – these exercises actually feel good! They are a mashup of yoga, Feldenkrais, Somatics, sometimes dance, and physical therapy. Rest assured that Sharon will work with you to carefully teach you the details of each exercise according to your muscle and bony structures. As you learn to perform these exercises with precision, you will also be taught how to breathe with each exercise to optimize its effects. This is relaxing and healing for body and mind. Once you feel confident with these exercises we worked together on in the clinic, these and only these exercises will become your home program – an important, if not the most important part of your physical therapy. Sharon will either draw stick figures to describe the home exercises, or if you like, she’ll video you doing them on your smart phone.

Then at the beginning of the next treatment, Sharon will check in with you to see how you’re doing. Is the pain decreasing? Increasing? What’s your impression of how you’re doing? What works and doesn’t work for you? When you have questions about the exercises, she will help answer them.

Your physical therapy treatment is designed to be progressive. Only after the pain has significantly gone down, and only when you say you’re ready, we slowly advance the exercises to strengthen and balance your body.

Healing with physical therapy takes time – your valuable time. To optimize your time and healing, wouldn’t you prefer to work with an experienced, integrative Physical Therapist who really hears you, who incorporates mindful breathing into discrete exercise instruction, who is skilled at using mind-body and holistic tools, one who has an arsenal of manual skills? If you’re truly looking to the best Physical Therapy NYC has to offer, wouldn’t this be the only way to go?


What are your Intentions?

I did it my way.
-Frank Sinatra

Why I prefer Intentions over New Year’s Resolutions 


Creating an intention is about finding out what I’d like to do or have happen in the New Year. It is a gentle process, one of tuning in and listening to the still small voice within. It’s a taking stock of where I am with my life today, and where I’d like to steer towards tomorrow. Am I heading in the desired direction? Do I want to tweak it here and there, or are we talking major changes here?

Resolutions connote differently. I RESOLVE TO sounds, well, like a legal document. Or the beginning of my Last Will and Testament. It’s a do or die proposition. It sounds authoritarian. Parental. Since I have issues with authority — who doesn’t — when faced with a directive like this, I tend not to listen. Or, if I’m in a particularly self-defeating mood, do the exact opposite. Besides, I don’t think that I ever kept even one New Year’s resolution. Have you?

Last year, my intention was to write morning pages* every day. It took me 4 or 5 months to get there. First I only wrote them at night once or twice a week. Then I started writing them more frequently, but still only at night. Maybe the late afternoon. For seven months now, because I want to, I write them just about every morning.

It took time to get here. I didn’t do it because I thought I should or because I obeyed an inner dictate. It came from a deeper, lighter place within. This process of daily writing grew into an activity I look forward to every morning. It grounds me deeply. It helps me to find the cheer and energy to face the day.

Check that one off the list.

This year my intentions are to meditate 10 minutes a day, and to write for this blog 10 minutes a day. Not publish, just write. Only 10 minutes. I’ve only been successful two days so far. It’s just something I want to do. I don’t have to.

Won’t you join me?


*The concept of morning pages was developed by Julia Cameron in The Artist’s Way.