Heat Vs. Ice: Best Practices for Injury Treatment

One of the most commonly asked physical therapy questions is, “Should I use heat or ice on my injury?” Both heat and ice can have pain-relieving effects if used appropriately and sometimes it may be ideal to use both. For instance, some individuals might heat up a chronically painful area before activity and ice it down after activity to decrease soreness. Both can be applied throughout the day, but you should allow 45 – 60 minutes between applications to avoid skin burn or frost bite.



What it does…

Heat increases blood flow and can help to relax and loosen tissues.


When to use it…

Heat is often used on areas that have been bothersome for some time or before participating in activities to avoid injury.


Examples of injuries requiring heat…

Tight backs and stiff legs typically respond favorably to heat before physical activity.


What it does…

Ice decreases blood flow and is often used to minimize swelling, inflammation, and irritation.


When to use it…

Ice is typically used on new injuries and swollen areas.


Examples of injuries requiring ice…
Back pain, which is caused by nerve irritation or inflammation, responds to ice better than to heat. A newly sprained ankle should be iced to decrease swelling and inflammation. Ice is also used after surgeries and can be used indefinitely to minimize pain and inflammation.

This is a general overview of the role heat and ice can play in the management and prevention of injuries. It is always advisable to consult your physical therapist before treating an injury.


Still have questions about heat vs. ice? Feel free to leave a comment below. We are happy to answer any questions you might have about this topic.



Vestibular Rehabilitation: An Effective Treatment for Dizziness, Vertigo, and Balance Problems

Do you suffer from dizziness, lightheadedness, or unsteadiness? If so, you are not alone. It has been estimated that 65% of individuals over the age of 60 experience dizziness or loss of balance on a regular basis and vestibular problems account for one-third of all patients with vertigo and dizziness.1, 2 Recent research by Johns Hopkins University suggests that as many as 35% of adults over the age of 40 in the United States (69 million Americans) have experienced some form of a vestibular dysfunction.3


What is the vestibular system?


The vestibular system lies deep within the ear and includes the utricle, saccule, and three semicircular canals. The utricle and saccule detect vertical and linear head movement and the semicircular canals detect rotational head movement. Both left and right vestibular systems constantly send information to the brain about your head position. The brain integrates this information with the input it receives from your eyes, muscles, and joints to assist in coordinating head, eye, and body movements to maintain equilibrium. When the vestibular system is not working properly due to illness or injury the input to the brain is altered and symptoms may develop including dizziness, vertigo, imbalance, nausea, and disequilibrium.

Vestibular System


What are common vestibular pathologies?


Common disorders of the inner ear include benign paroxysmal positional vertigo (BPPV), vestibular neuritis and labyrinthitis, acoustic neuroma, bilateral loss of inner ear function due to ototoxicity or autoimmune disease, and Meniere’s disease. Other conditions that may cause dizziness and/or imbalance that would benefit from vestibular rehabilitation include cervicogenic dizziness, and brain damage from head trauma, tumors, and stroke.



What is Vestibular Rehabilitation?


Vestibular rehabilitation is a specialized type of physical therapy in which specific exercises are used to promote brain/central nervous system compensation for inner ear deficits. Your physical therapist will perform a thorough assessment and develop an individualized treatment program aimed at decreasing your symptoms and improving your function.


A treatment program may include:

  • Balance/coordination activities to retrain body awareness
  • Gaze stability exercises to decrease dizziness
  • Flexibility and/or strengthening exercises
  • Particle repositioning maneuvers to treat BPPV



Does Vestibular Rehabilitation work?

Research suggests that vestibular rehabilitation therapy is very effective in reducing symptoms of many types of vestibular disorders.Additionally, multiple randomized controlled trials provide strong evidence that the Canalith Repositioning Maneuver (Epley Maneuver) is very successful in treating BPPV in as little as one to two sessions.5, 6, 7


What is the next step?


Many other serious health conditions can cause dizziness including cardiovascular, neurological and metabolic problems. If you experience dizziness discuss your symptoms with your health care provider to determine if you are a good candidate for vestibular rehabilitation.


Please email me if you have questions about all of this.



1 Hobeika CP. Equilibrium and Balance in the Elderly. Ear Nose Throat J. August 1999; 78(8): 558-62, 565-6.

2 Neuhauser HK, Radtke A, von Brevern M et al. Burden of Dizziness and Vertigo in the Community. Arch Intern Med. 2008;168(19):2118–2124.

3Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of Balance and Vestibular Function in US Adults. Arch Intern Med. 2009: 169(10): 938 944.

4 Hillier SL, Hollohan V. Vestibular Rehabilitation for Unilateral Peripheral Vestibular Dysfunction. Cochrane Database of Systematic Reviews 2007. Issue 4. CD005397.Pub. 2; 2007.

5 Helminksi J, Janssen I, Hain T, Zee DS. Effectiveness of Particle Repositioning Maneuvers in the Treatment of Benign Paroxysmal Positional Vertigo: A Systematic Review. PHYS THER. 2010; 90:663-678.

6 Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, Hain TC, Herdman S, Morrow MJ, Gronseth GS. Practice Parameter: Therapies for Benign Paroxysmal Positional Vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurol. 2008;70:2067–2074.

7 Hilton M, Pinder D. The Epley (Canalith Pepositioning) Maneuver for Benign Paroxysmal Positional Vertigo. Cochrane Database of Systematic Reviews 2004. Issue 2.


Distinguishing Between Physical Therapists and Personal Trainers in New York State

This is a question that we are frequently asked: What is the difference between a physical therapist and a personal trainer? Both professions are passionate about health and wellness, however there are distinct differences between the two. The information below provides a side-by-side comparison of the two professions.


Please email me at apokorski@sptny.com if you have any questions about this.  It is important that people are seeking the appropriate service and advice for their goals and/or condition.


Physical Therapists:


Licensing: Physical therapists are state board licensed health care professionals in the state in which they practice.


Education: Physical therapists graduate from an accredited college or university, most with Doctorate of Physical Therapy degree. It is a 3-year program that follows undergraduate prerequisites.


Settings: Physical therapists work in a medical setting – often private practices and hospitals, and in short and long-term care settings. Physical therapists can evaluate a patient with or without a physician’s referral (a.k.a. Direct Access).


Area of expertise: Evaluation, treatment, and prevention of disability, injury, and disease are physical therapists’ specialties. They are skilled at a variety of techniques including exercise, manual techniques, and modalities to assist in the healing process. Physical therapists undergo significant coursework on anatomy and physiology of the human body. 


How would a physical therapist utilize a personal trainer? A physical therapist will often refer a patient to a personal trainer after that patient has successfully completed physical therapy following an injury or post-operative care. The personal trainer can guide the client through high-level, sport-specific training to create optimal performance in their chosen activities.

Personal Trainers:


Licensing: Personal trainers are not licensed. They hold a national certification through NASM (National Academy of Sports Medicine), ACSM (American College of Sports Medicine) or ACE (the American Council on Exercise).


EducationMany personal trainers have a degree in exercise physiology, however a degree is not required.


SettingsMany personal trainers work in health club settings or are available for one-on-one exercise training or enhancement sessions.


Areas of expertise: A personal trainer is a fitness professional involved in exercise prescription and instruction. They motivate clients with goal setting, feedback, and hold clients accountable to their goals with measurements. Their training is often related to strength building, performance enhancement, or weight loss. Education on wellness, exercise, and general health is part of a personal trainer’s responsibility to their clients.


How would a personal trainer utilize a physical therapist? When a personal trainer sees an injury or pain that prevents full participation in an exercise program, then the personal trainer would refer that client to a physical therapist for diagnosis, rehabilitation and treatment of the injury. A personal trainer will also recommend a physical therapist for a client planning for post-operative rehabilitation.



Sports PT works with many health clubs across New York State to serve patients as they transition to daily fitness programs. Yesterday, we celebrated National Physical Therapy Month with our friends at The Buffalo Athletic Club in downtown Buffalo…




Earle, Roger (2004). NSCA’s Essentials of Personal Training. NSCA Certification Commission. pp. 162, 617. ISBN 0-7360-0015-1.

New York Physical Therapy Association. http://www.physical-therapist-requirements.com/state-requirements/new-york.

New York State Education Department. http://www.op.nysed.gov/prof/pt/article136.htm.

American College of Sports Medicine. http://certification.acsm.org/.


Do You Really Need Surgery? Ask a PT Before Going Under the Knife

After suffering an injury many people’s first thought is “Will I need surgery?” Depending on the type of injury, surgery may not be the only option. Many patients have had a great deal of success with going through physical therapy before pursuing surgery. Physical therapy has proven to be highly successful in decreasing pain and improving range of motion, strength, and ability to perform normal daily activities in the home and at work, even for people who thought surgery was their only option.

The METEOR study (Meniscal Tear in Osteoarthritis Research) compared patients with knee arthritis who received physical therapy without surgery and those who underwent an arthroscopic knee partial meniscectomy (a.k.a. knee scope) surgery. Both groups improved similarly in function and pain. 1 Another study, published by the British Medical Journal, compared sciatica patients treated with surgery to patients who only received PT. According to that study, the patients who received surgery experienced short-term benefits but after six months there was no difference between patients who had undergone surgery and those who had received PT alone.2


Surgery is not always the quickest, or most effective, fix for pain and function. It is important to look at all options, as surgery entails healing time and often post-operative PT as well. Other than the physical stress of surgery, consider the emotional and financial stress that surgery may cause. If you are considering surgery, please reach out to your local Sports PT of NY clinic to set up an appointment. We will assess your injury and help you decide if you are a surgical candidate or if PT alone can restore your function.




1 Surgery vs. PT for a meniscal tear and OA. The NE Journal of Medicine. Published March 19, 2013.

2 Prolonged conservative care vs. early surgery in patients with sciatica caused by lumbar disc herniation: two-year results of a randomized controlled trial. Peul WC, et al. British Medical Journal. 2008; 336: 1355-8.

Before Making Another Doctor’s Appointment for Pain, Consider Going Direct to a PT

Do you need a referral to see a Physical Therapist?


In November 2009, New York State passed a law that allows patients to have “Direct Access” to Physical Therapists. This permits an individual to gain access to a Physical Therapist’s expertise without seeing an MD first. Physical Therapists are movement specialists that can diagnosis, treat, and work on existing pain and help you prevent future injuries. Most Physical Therapists have their doctorate degree, and are fully equipped to advise on and treat a wide range of conditions.


Can you see any Physical Therapist?


You can be seen by a licensed Physical Therapist with at least three years of experience for ten visits or 30 days without a referral (a.k.a. a script) from your physician. The majority of insurance companies support Direct Access. If you aren’t sure if you have Direct Access benefits, Sports PT can verify that ahead of time as a courtesy.


What are the primary benefits of Direct Access?


  • Prompt access to orthopedic evaluation and treatment within 24 hours
  • No need to go through the formality of seeing a Medical Doctor or Urgent Care facility first
  • Time and co-pay savings
  • A PT can quickly determine if an physician consult is required
  • Quicker recovery time


Direct Access Testimonial


We’ve had several patients take advantage of the Direct Access benefit with great results!  Direct Access is an excellent way to speed your recovery and streamline your healthcare needs. Contact us for more information.



http://www.apta.org/StateIssues/DirectAccess/. Updated 7/23/13.