As a sports medicine professional, one of the most common questions I am asked is when to use ice and when to use heat for an injury. This is a great question because both can be extremely beneficial but should be used at different times. Before we discuss when it is best to use ice vs. heat, it is important to define the two basic types of athletic injuries, acute and chronic.
Acute pain has a rapid onset and is short-lived. This is the result of a recent injury (within the last 48-72 hours) where swelling is present. These injuries are typically traumatic in nature resulting from some sort of impact or trauma such as a fall, a sprain, or collision. They usually happen suddenly and it’s fairly obvious what caused the injury. Common signs and symptoms of acute injuries are sudden and severe pain, tenderness to the touch, redness, skin that is warm to the touch, inability to place weight on a lower limb, swelling and inflammation. If you have swelling, you most likely have an acute injury!
Chronic pain develops slowly, is persistent and long-lasting. Chronic injuries can be very subtle and slow to develop and are sometimes referred to as cumulative trauma or overuse injuries. They can come and go, and may cause dull pain or soreness. Chronic injuries are often the result of overuse but can develop when an acute injury is not properly treated and doesn’t heal.
Ice or Cold Therapy
Ice (or cold therapy) is the best treatment for acute injuries. Ice will decrease the swelling which will in turn reduce the pain. Ice is a vasoconstrictor. This means it causes the blood vessels to close which will limit the internal bleeding to the injury site.
Now, ice can also be used to aid in the treatment of chronic or overuse injuries as well. If you have a chronic injury which increases in pain or swelling after activity, use ice to help decrease these symptoms. Remember, for chronic pain, ice should only be used after activity and never before activity.
Heat is best used for chronic pain or chronic injuries. Sore, stiff and aching muscles as well as joint pain are best treated with heat therapy. It should be used for injuries that have no inflammation or swelling. Heat is a vasodilator causing the blood vessels to open. This will stimulate blood flow to the injured area which will help promote healing. Using heat on a chronic injury before exercise will increase the elasticity of joint connective tissue and increase blood flow. It also will help relax tight muscles and decrease muscle spasms.
Do not apply heat after exercise. Again, ice is best following activity or a workout. As mentioned, heat will increase circulation and in turn raise the skin temperature. Therefore, heat should never be applied to an acute injury or an area that shows signs of inflammation.
Helpful Hints and Reminders
• Always use ice on an acute injury or when there is swelling (use only ice for 48-72 hours immediately after an injury)
• For chronic pain, heat before activity and ice after activity
• Ice packs should never be placed directly on the skin to avoid frostbite
• For an additional benefit when treating swelling, elevate the area being iced
• For areas that you can reach, an ice massage works great. To do this, fill up several paper cups with water and place in freezer. Once frozen, peel back the top of the cup and while holding the bottom of the cup, massage the area with the ice for 10-12 minutes.
• Another effective way to ice an area is to soak a thin washcloth in cold water, wring it out and place over the affected area. Next, place a bag a frozen peas/vegetables on top. An Ace wrap may be needed to keep the bag in place.
• For icing hands or feet, soak in a bucket of ice water for 10-15 minutes.
• Do not apply ice for longer than 20 minutes at a time
• Do not apply heat for longer than 20 minutes at a time
• Moist heat is best (use a hot, wet towel)
• Make sure you use plenty of layers between your skin and the heating source to prevent burns. It is also recommended to check the skin every 5 minutes to check for burns
• Never leave heating pads on while sleeping
• If you use heat often, special athletic heating pads can be purchased
• How long should one wait between heating or icing sessions? With any heating or icing, if a repeat session is needed, wait until the skin is completely back to normal in appearance and temperature. This usually takes between 30 and 60 minutes, depending on the individual’s response. Never reapply heat or ice before the skin has completely recovered
• Contrast baths (alternating between heat and ice) can be very effective for athletes who need to reduce swelling in the extremities very quickly. This method promotes the opening and closing of blood vessels to pump swelling out of the area. This is done by alternating between heat and ice for 20 to 30 minutes. Simply apply heat for 2-3 minutes, and then apply ice for 2-3 minutes. This is repeated for the duration of the treatment. This technique is not used to reduce pain.
Because many injuries can be very serious in nature, please contact your doctor if your injury does not improve (or actually gets worse) within 2-3 days.
Jeff Booher is a regular contributor for InjuReplay and owner of Peak Physical Therapy and Sports Performance located in Lincoln, Nebraska. Learn more about Jeff and his sports medicine background HERE.