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Ice or Heat?

Last Updated: Dec 23, 2012

The eternal question for someone in pain: “I injured my <blah blah> … so should I use ice or heat?”.

Good question – It’s not always that obvious! Here are some simple guidelines based on the contemporary theories of how and why you should use it.

The decision is usually made on two factors: time after injury, and reason for use. There are a couple exceptions, as well as safety concerns, listed on the bottom.

Time after injury:

Acute injuries are usually treated with ice, or ‘cryotherapy’ (see PRICE for a summary of acute injury treatment). This is the first two to three days, up to two weeks depending on the severity. It’s during this phase that inflammation is most severe. Plus, ice seems to be effective for pain in new injuries. Decreasing inflammation and pain should help you move, perhaps allowing you to return to sport faster 1.

Chronic injuries are usually treated with heat. This is when an injury is a few weeks old and beyond. Inflammation should be under control by now, and pain has more to do with the nervous system, muscles stiffness, and a lack of mobility. Heat can help with each of these things, and from my experience, people usually prefer heat anyway.

Confused? Not sure whether your injury is in the acute or chronic phase? Perhaps it’s one of those pesky ‘repetitive stress injuries’ See: How Injuries Happen. Try ‘contrasting’, doing 20 minutes of heat, then 20 minutes of ice (or vice versa), then rest 20-60 minutes, and repeat as much as you like.

Reason for use:

Ice is usually for ‘flared-up’ injuries. Not just acute (new) injuries either. Sometimes swelling or inflammation can remain for a longer time than usual. Or, you can aggravate an injury that may not be fully healed (it’s not always inflamed). Furthermore, repetitive strain injuries may not have a clear time of onset or mechanism of injury, so knowing what phase of healing you’re in can be confusing.

If its a newly or re-aggravated injury of any sort, it will probably like ice.

Heat is for discomfort. Although that is an ambiguous answer, it pretty much covers it. Of course, discomfort can come from an inflamed (where ice is recommended) injury too, but not always.

Discomfort usually means achy type pain, and that stiff feeling at your joints or muscles. In joints it may feel like tight pressure, in muscles it may feel more like stiffness, as if you needed a massage or stretch, only with more pain. Either way, heat feels great and may temporarily increase range of motion, giving you a window of opportunity to get some early mobilization to help recovery.

Both heat and ice are helpful for pain. In this case it doesn’t really matter what you use, as long as it feels relieving. 2, 3, 4 It’s very subjective, and the research isn’t great, 5, 6 but it’s definitely worth a shot.

Exceptions: Almost never heat something that is swollen and hot… ask a professional first, it could be chronic inflammation or an infection. And Paul Ingraham at saveyourself.ca makes a great case for the fact that heat is usually much better for low back and neck pain, even if it’s new pain. If you are still confused, try contrasting ice/heat as described above!

In the end, it probably doesn’t matter what you choose. The science is still unclear (yes, even for something so basic as heat/ice), so other than the warnings below, don’t worry about it too much.

Your best option is whatever you think feels good, relieves your pain, and allows you to move comfortably.

Contraindications huh? (no, I didn’t mean ‘contradictions‘)

In plain English, these are warnings. Don’t use heat or ice in these cases. If you’re not sure, check with your doctor. read: disclaimer!

Check for red flags.

Do not use heat on:

  • Areas of decreased sensation
  • On open wounds
  • Acute inflammation or hemorrhage
  • Bleeding disorder
  • Known malignancy (tumor)
  • Full body heat (like a tub) when one has conditions affecting core temperature like: Multiple Sclerosis., Adrenal Suppression, Pregnancy, and Lupis.

Do not use ice on

  • Areas of decreased sensation
  • Known malignancy (tumor)
  • Hypertension
  • Raynaud’s disease
  • Circulation concerns, such as ischemia, frostbite or arteriosclerosis
  • Cold allergy (yup)
  • Rheumatoid arthritis

Look these things up, or preferably, go to a doctor if you are not sure.

Okay, so how do I use heat or ice?

Now that you better understand (hopefully) the difference between using ice and heat, here are some more detailed ‘How-to’ guides:

That’s it!

Good luck!

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