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Cold vs Heat Therapy -When To Use Ice and Heat Therapy

Posted on August 24 2023

Much of todays use of cryotherapy, or cold pack treatments are during the acute or early stage of injury. We've all see young athletes running around the gym, school or ball field juggling a dripping bag of ice, stopping 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 athlete to sit still, let alone strap an uncomfortable bag of ice to themselves.  However, the simple routine of utilizing cold therapy 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? While heat generally fells better on the surface, it's mostly used for pre-activity to help relax "warm-up" stiffness in the joints, treat chronic injuries and promote blood flow.

The use of cold therapy is designed to physiologically block pain. When a muscle is in its shortened state, it can program a repeating or looping process to influence nerves in the area to continually spasm.  These spasms can be painful but eventually broken with the use of an ice wrap or cold therapy. This all essentially revolves around the gate theory of pain. In a nutshell, the application of a cold pack or ice wrap is used to bring the muscle back to a more natural resting state without producing more pain.  The common acronym R.I.C.E (Rest, Ice, Compression, Elevation) is still the best rule of thumb for immediate onset injuries. Despite keyboard warriors and social media attempting to recently denounce its efficacy, the use of ice therapy is proven effective in the initial treatment of sprains, strains and contusions. The use of cold therapy by way of ice bath, ice packs and ice wraps following a tough workout can assist in recovery and help prevent the many overuse injuries and conditions that plague many athletes today. A proper cool-down is just as important as a proper warm-up.

Cold therapy comes in many forms, ice cubes, ice packs, gel ice packs, topical gel,cryo-chambers and gaining in vast popularity portable ice tubs or cold plunge tubs. I tend to steer clear of any toxic chemical-based instant packs especially when dealing with young athletes. Of all the options, I find that ice wraps are the easiest and most economical to use. When using cold therapy it's important to understand the stages of the application. 

Stage 1: Cold (burrrrr)- This is the initial feeling of the ice wrap application

Stage 2: Aching- This occurs after 3-5 minutes

Stage 3: Warming Sensation- This is after 5 minutes but should not be sharp or extreme burning.

Stage 4: Numbness- This could be around 7 -15 minutes.

Cold therapy DOES NOT need to be teeth chattering and should only be applied typically for 15 minutes sessions (unless the temperature is more on the "cool" (say between 40-60 degrees F). Too much cold, just like too much heat (sun) can be damaging to the skin. So time duration is important and should be monitored. More is not always better. Some individuals can be very sensitive to cold so make sure your athlete has a barrier between skin and cold treatment. Cold is generally applied during the first 48-72 hours or until swelling has subsided.