Should I Use Ice or Heat On My Injury?

When do you use an ice pack and when do you use a heat pack on an injury? How do you choose heat or ice for pain relief? What about using ice or heat for sore muscles? Well most agree that heat generally feels better on the surface you may quickly become a fan of the benefits of ice for injuries if it suits your physiological make-up. In my 30 plus years of applying these modalities, I have found that deciding whether to use heat or ice for pain relief is a combination of science and personal preference.

Using heat for sore muscles in the rehab setting typically entails moist heat, ultra sound, and whirlpools/therapeutic pool. For home use, reusable heat packs are used to relieve stiffness after inflammation resolves. Moist heat can offer relief from chronic irritation and stiffness in tendons (Tendinosis) and arthritic stiffness. Though using heat for sore muscles is a great treatment, heat should not be used on inflammation or acute injuries as a basic rule. 

Using ice for injuries and injury prevention is a classic therapy method. Cold therapy is designed to physiologically block pain. If you are not a big fan of taking pain meds, anti-inflammatories(NSAIDS) and their possible side-effects, then using an ice wrap is going to be your go to modality. How does ice block pain 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 ice pack application is used to bring the muscle back to a more natural resting state without producing more pain. Arthritic flare ups, headaches, strains/sprains, tendinitis and post op swelling are all good cases to use ice or a reusable ice wrap. Not to be left out is the use of ice or an ice pack following a tough workout. Cold therapy can assist in recovery and help prevent many of the overuse inflammatory injuries that plague elite level athletes and weekend warriors alike. An ounce of prevention can really go a long way for an athlete. Remember that a proper cool-down is just as important as a proper warm-up. 

Cold therapy is offered in many forms from ice baths, ice cubes, cryotherapy chambers, motorized ice therapy machines, reusable ice packs and topical gels just like grandpa use to use. My experience is that if an ice wrap is easy and comfortable for an individual to use 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 many but once they’ve made it past the initial stage it becomes rather soothing for the remaining duration. The cold does not have to be teeth-chattering and should be applied for no more than 15-20 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. More time does not equate to more healing. Deeper tissue areas such as the shoulders and hips can handle more cold than hands, feet or the posterior aspect of the knee. Some individuals with neuropathy or Raynaud's can be ultra-sensitive to cold so make sure there is a barrier (paper towel or thin layer of fabric) between the skin and cold treatment. Cold should not sting like pins and needles or increase pain...if it does its time to remove. Cold is generally applied during the first 48-72 hours or until pain has reduced and swelling has subsided.

Using heat for sore muscles and ice for injuries is a great way to treat pain. For more info on deciding whether to use heat or ice 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.