Should I Use Ice or Heat?


There is sometimes confusion about the right time to use ice or heat when treating an injury or condition. When used properly these methods can greatly improve the outcome of an injury by helping to control swelling and inflammation and to promote tissue healing and repair. This can help achieve less pain intensity and increase healing time. This article addresses the proper times for the use of these techniques as well as some instructions and precautions.


When to Use Ice


Ice can be used for new or acute injuries. This is especially helpful in the first 48-72 hours following most injuries to help reduce pain and control swelling. Your body is usually reacting to an inflammatory process and irritation during this time frame. Ice is effective for pain reduction. It can also be used for chronic conditions or overuse injuries. Ice is helpful after activity to reduce swelling and inflammation. Examples of this are tendonitis, shin splints, muscle strains or joint sprains. As you resume activity following an injury it can be helpful to use ice after a session/workout. For any flare up of an old injury it is also helpful to apply ice.


Generally speaking ice can be used for approximately 15-20 minutes. You should allow the treated area to warm up to body temperature for at least 45 minutes after applying ice before the next application. For acute or severe strains/sprains it is helpful to ice several times a day.


How to Apply Ice


  • Ice Cubes/Crushed Ice – These should be placed in a Ziploc bag to avoid leakage. This method can allow for some flexibility when treating awkward shaped or bumpy regions of the body thus allowing for more surface area contact.

  • Ice Massage – Fill some paper cups with water and freeze them. Then take a cup, tear the bottom off and massage the ice over your injury in a circular pattern allowing the ice to melt away. This method can be performed directly on the skin as you are constantly moving the ice. This is considered one of the best methods.
  • Freezable Gel Pack – This method also allows for some flexibility. There are numerous sizes of frozen gel packs available to treat large or small areas. This method also tends to be least messy. These packs can be used over and over again, but will require some time to re-freeze after an application. It is advisable to have 2-3 gel packs available for this reason.
  • Frozen Vegetables – Bags of frozen peas/corn can be used when ice packs are not available.
For all methods (with exception of ice massage) it is advisable to place a thin towel between the ice and skin for protection.


When to Use Heat


Heat can be helpful for some chronic, persisting or long-term conditions to relax/loosen muscles and improve blood flow to the area to promote healing. Heating body tissues can be accomplished using a heating pad or a hot (not scalding) wet towel. When using heat treatments, be careful to use only mild to moderate heat for a limited time to avoid burns. Heat should not be used right after vigorous activity and never for a new or acute injury. This is because there is already a presence of heat, swelling and inflammation in these situations. Take care not to overuse heat in order to avoid burns. Heat should not be used for more than 20-30 minutes per session and generally no more than 2-3 times per day. Never leave a heating pad on for extended periods of time such as overnight. Too much heat can lead to skin burns and cause increased swelling and inflammation. This will work against what you are trying to achieve. A common mistake people make is using heat too early or too often for their injury. Just because the pain and symptoms may be temporarily relieved or “soothed” while using the heat does not necessarily mean that it is helping the injury heal.


When to Use Both Ice and Heat?


Some conditions would benefit from both ice and heat. For chronic pain and overuse injuries you can get some benefit from using heat prior to activity and ice following the activity. The heat will allow for some increased blood flow to the area to prepare for activity/exercise. However, the activity itself can cause an increase in strain and inflammation. Therefore, using ice immediately after the activity can be helpful in reducing post-exercise symptoms. This will often help reduce delayed onset muscle soreness and residual complaints that can follow activity. It may also reduce potential symptoms/pain you would otherwise notice the following day. This approach can be used for chronic or recurrent neck and back pain as well as tendonitis, for example, tennis elbow.


Alternating ice and heat can also be helpful for sub-acute injuries when the objective is reducing inflammation but at the same time wanting to encourage blood flow to an area. This is generally used a few days after an injury. The sub-acute phase can begin 3-6 days after an injury when the body is starting the repair process.


Contraindications to Ice and Heat


There are times when the use of ice or heat may be contradictory and harmful in the proper healing of an injury. Do not use electric heating pads in bed or other situations where it could be left on too long as this can cause severe skin burns or tissue damage.


The following are some contraindications (inappropriate times) for ice use:
  • Cold hypersensitivity (i.e. Raynaud’s Phenomenon)
  • Sensation changes (the degree of cooling cannot be felt)
  • Large open wounds
  • Areas of impaired circulation
  • Rheumatoid arthritis


The following are some contraindications (inappropriate times) for heat use:
  • Acute phase of an injury
  • Burns or other heat injury
  • Sensation changes (when you can’t feel if it is too hot)
  • Hyper or hypo-sensitivity to heat
  • Circulation problems
  • Infections
  • Malignant/cancerous tumors
  • Deep vein thrombosis (DVT)


Exceptions to the Rule


There may be times when ice is important beyond the initial 2-3 days of an injury or when an alternative approach to the use of these therapeutic treatment modalities is needed.


For true back spasms ice may cause increased spasms after the first couple of attempts. In this scenario it may be helpful to use short periods of heat earlier. You may actually be experiencing only tight muscles without swelling/inflammation present and the ice could increase the spasm. This occurs less commonly.


Please make an appointment to consult with the doctors at Coon Rapids Chiropractic Office for treatment recommendations regarding your individual situation.


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The International Academy of Neuromusculoskeletal Medicine