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Cold or Heat?

Posted on September 20 2012

 Cold vs Heat Therapy

Written for Inside Gymnastics Magazine Coaches Guide 2006 

Much of today’s use of cryotherapy for pain relief in the gym is in the acute or early stage of injury. We have all seen young athletes running around the soccer field or gymnasium juggling a dripping bag of ice, stopping only momentarily to slurp a little drink from the corner of the bag in youthful naivety. Let’s face it…it’s tough enough to get an energetic youngster to sit still, let alone strap an uncomfortable bag of ice to them as well. However, the simple routine of utilizing cold wraps or ice wraps can go a long way in keeping your athletes healthy. But when do you use cold and when do you use heat on an injury? Well most of us agree that heat generally feels better on the surface. Heat is frequently used for pre-activity to help relax stiffness in joints and the chronically injured. Heat can play a nice role in improving muscle stretching prior to exercise, hence, the term warm-up. A fun little demonstration is to show your athlete a frozen rubber band and a warm rubber band and demonstrate what stretches longer without breaking.

Cold injury treatment is designed to physiologically block pain. How, you ask? Well when a muscle is in its shortened state, it can program a repeating process to influence nerves in the area to continually spasm. These spasms can be painful but eventually broken with the use of cold therapy. We can dive into a complex discussion on the physiological process known as the gate theory of pain here but we’ll save that for another day. In a nutshell, the cold pack application is used to bring the muscle back to a more natural resting state without producing more pain.

The common acronym P.R.I.C.E. is still the best rule of thumb for immediate onset injuries and ice application, otherwise known as Protect, Rest, Ice, Compression, and Elevation. P.R.I.C.E is very effective in the initial treatment of soft tissue injuries such as sprains, strains, and contusions. The use of cold therapy following a tough workout can assist in recovery and help prevent the many overuse injuries that plague the sport. An ounce of prevention can really go a long way for a young athlete. Remember that a proper cool-down is just as important as a proper warm-up.

Cold injury treatment can come in many forms. Ice cubes, cold baths, gel packs,ice wraps and topical gels have all been utilized at one time or another. When dealing with young athletes, I tend to steer clear of any toxic-chemical based instant packs for the simple reason of safety and curiosity. My experience is that if a cold wrap is easy and comfortable for a youngster to wear then they will actually follow through with the treatment and eventually make a habit of doing it for prevention. The first couple minutes of cold may be tough to swallow for the young athlete but once they’ve made it past the initial stage it becomes smooth sailing for the remaining duration. The cold does not have to be teeth-chattering and should be applied for no more than 15 minutes at a time. Just remember, too much cold can be damaging to the injury and the underlying tissue, so time duration is very important. Some individuals can be very sensitive to cold so make sure your athlete has a barrier (paper towel or thin layer of fabric) between the skin and cold treatment. Cold is generally applied during the first 48-72 hours or until swelling has subsided.

For more info on using heat treatments and cryotherapy for pain relief, see our updated blog post here:

Heat or Ice for Knee Pain?

By Shawn J. Hickling BSc, PTA Shawn received his degree in Exercise Physiology from Chapman University. 

He has worked in the field of Sports & Orthopedic Physical Therapy for over 15 years and is the founder of ActiveWrap Inc. 2003-2004 Official Therapy Wrap of USAG and United Spirit Assoc.