When to Ice, When to Heat


IceIce or heat on an injury, that is the question. It’s a common concern for many people dealing with both short and long term injuries, and a frequent question from our clients. Do you know when to recommend heat versus cold therapy?

Before you can determine if you should use ice or heat, determine if the injury is acute or chronic. An acute injury is defined as specific, sharp pain caused by a traumatic event which causes injury – such as a sprain. Many of us have twisted an ankle during physical activity. This would be considered acute injuries where immediate inflammation occurs. Inflammation is the body’s natural response to an injury. The injury gets red, hot to the touch, and swollen because the body – in its infinite wisdom – is sending more blood to heal the injured area. Inflammation also reduces the joints range of motion which help prevent additional trauma.

In cases of acute injury, immediately apply ice. Applying ice reduces the pain in an area by numbing it while also reducing swelling and bleeding in the soft tissues. The sooner ice is applied the less difficult it will be to get the swelling to reduce around the joint, and the sooner the injured person can return to normal activities.

Tips for Your Clients on Icing Acute Injuries:

  • Always having on hand a freezer or instant gel ice pack.
  • Use a thin towel between the injured area and the pack. The towel prevents burning the skin when the ice pack is too cold
  • Check the skin of the area after 5 minutes. If the skin is bright red or pink, remove the pack. If it’s not then allow the pack to stay on for another 10-15 minutes.
  • Continue to ice the injury every few hours for 5-15 minutes.
  • Stop icing about 48 hours after the initial injury.

A chronic injury is defined as an injury that develops slowly, is persistent, and long-lasting with mild to low grade pain. Chronic injuries are often nagging pains that can be overlooked or ignored for a period of time.

When dealing with a chronic injury you want to apply heat, except after exercise. After exercise, if a chronic injury feels worse then apply ice to help reduce pain and inflammation. The use of heat is soothing to the muscles, increases elasticity to the connective tissues and stimulates blood flow. However, in some cases, ice works better in long term treatment of a chronic injury due to extreme inflammation. Many chronic injuries are a result of overuse and repetitive strain. It’s easy to ignore these small pains but if you do they could eventually grow into a larger problem and take much longer to heal. In order to avoid this, pay attention to your body. If you feel a dull aching pain, don’t ignore it. Take the necessary time to administer some heat to the area. A warm bath, heat cream, or sitting with a heating pad on the area may help. If you have a nagging injury, do not ignore it!

As a general rule, ice is used to reduce inflammation for new injuries, and heat is used to soothe and relax chronic injuries. And of course, recommend that your clients consult their physician for specific advice on the treatment of their injury.



One Comment on “When to Ice, When to Heat

  1. Another excellent article Holly!

    As an alternative method for cryotherapy, or ice, I use ice directly on the skin, but move the ice for an ice massage. It is very efficient (much quicker to numbness) and provides the benefits inherent in a massage. I use a product known as Cryocup, that provides a large “ice cube” with a plastic holder, facilitating the ice massage. It’s about eight bucks and is very re-usable.

    Alternatively, you can use a paper cup, fill with water & freeze; then tear of the lip to expose the ice & leave you the paper bottom to hold when ice massaging. I recommend watching the clock, or setting a timer. Never more than 20 minutes. With ice massage, it takes only eight to ten minutes, although I strive for 12 to 15 so that the physiological benefits (e.g., regional removal of debris) are ensured.

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