Injuries: Ice or Heat?

A question I am asked all the time is when something hurts should you use ‘Ice or Heat?’.  As always the

answer is – it depends……


When you initially strain a muscle or sprain ligaments or tendons there are tears in the fibre, bleeding and swelling.  This leads to inflammation and heat being radiated from the area as the dead cells are removed and new ones brought in to start the healing process.

There can also be a lot of pain at this point.  Ice cools, soothes, reduces blood flow and swelling and is a natural pain reliever so is perfect during this time.  What you need to be aware of is not over icing the area.   Uncontrolled swelling can cause more damage than good but if there is no inflammation at all then the necessary cells are not being brought to the tissue for healing.   Inflammation is important which is why timing is key – do not over ice an injury.  Here are some guidelines on when and how to use ice:

  • If the pain is acute, sharp, intense and if there is swelling or heat in the area.
  • Generally the fist 24-72 hours after you have sustained an injury.
  • An ice pack, bag of frozen peas or even some ice cubes in a plastic bag can be used to ice the area.
  • Use a thin towel over the skin, do not apply ice directly to the skin.
  • Ice for about 10 minutes at a time 3-4 times a day during this time.
  • Combine with Rest, Compression and Elevation of the damaged area to also help reduce the inflammation.

Heat is great at loosening up muscle tissue, increasing flexibility in the fibres and reducing muscle spasm.  Knowing this it makes it easier to identify when the right time is to use heat.  After the acute stage of injury we talked about above, the pain usually changes.  It can be less sharp, less hot, less swollen but still painful, achy and maybe stiff.  This is described as the sub-acute stage of healing.  The new fibres have been laid down but they are stiff, wiry and sometimes still painful.  This means its time to move to heat.  But what if you didn’t strain or sprain something but are experiencing muscular pain?  Sometimes our day to day activities lead to chronic postural imbalances shortening and tightening muscles that then go into spasm.  We want to encourage these muscles to relax and lengthen to reduce the pain you are experiencing.  Applying Ice may shock the fibres into shortening further so its important that we apply heat if this is the kind of muscular pain you are experiencing:
  • Do not apply heat to inflammed newly damaged tissue – it will increase bleeding and swelling and may cause further tissue damage.
  • If pain is dull, achy or chronic then it is likely that heat should be applied instead.
  • If muscles are tight, stiff or in spasm heat again can be useful.
  • Heat should be applied by a hot water bottle, heat pack, microwaveable bean pack etc. for 10 -15 minutes at a time.  This can be repeated 3-4 times a day if needed.


Next time you are in pain think about what type of pain it is and how long it has been there before deciding to reach for the bag of peas or the hot water bottle!


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