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Ice vs. Heat: When to Use Which

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While the debate continues on how beneficial icing is to injury recovery, the question of if and when to use ice versus heat is a little more cut and dry. And for some situations, you can even use both, although not at exactly the same time.

Ice vs. Heat

Since the late 1970’s, when the RICE (Rest, Ice, Compression, Elevation) protocol was touted as the gold standard for treating soft tissue injuries, we have slapped ice packs on everything from bumps on the head, bloody noses and bee stings to bruises, sprained ankles, pulled muscles and everything in between. We plunge ourselves in ice baths and even pay hundreds of dollars for whole body cryotherapy sessions during which the body is exposed for two to four minutes to temperatures colder than negative 200 degrees.

And now that ice is believed to delay the healing process because it stops inflammation, which is a critical part of the process, some are looking to heat as a more beneficial option. However, just because medical professionals are rethinking the use of ice, doesn’t mean that you should automatically rush to heat things up.

Heat does dilate blood vessels and increases blood flow to an injured area, which can stimulate healing. And like ice, heat also can relieve pain, although the mechanisms are different. Ice is a numbing agent whereas heat is a relaxing agent.  And although heat and ice both can relieve pain and stimulate healing, there are very specific uses for each under very specific conditions.

When to Chill Out

In general, ice can be used to numb pain and reduce swelling on acute injuries that are less than six hours old. This include things like sprains of the ankle, knee, foot, shoulder, elbow; pulled muscles or injured tendons in the thigh, back or calf; or contusions. Ice also can be used to reduce the inflammation of tendinitis after physical activity.

But, because too frequent icing for too long can slow the healing process and can even result in nerve damage or tissue death, it should only be used in the first few hours after injury and then only for 10-minute periods at a time.

Ice packs can be purchased from a drugstore or can be nothing more than a zippered plastic bag of ice cubes. Bags of frozen peas or corn also can be used as they conform easily to the injured area. Do not place ice, ice packs or bags of frozen peas or corn directly on the skin as it can result in skin damage. Place a washcloth or thin towel between the ice pack and your skin.

When to Heat Things Up

Heat is most often used to relax muscles and ease stiffness of joints. Heat is indicated in conditions such as arthritis and low back pain, even after its onset, because it is frequently caused by muscle spasms. Heat also can be used for sprains, strains and tendinosis (chronic irritation and/or stiffness in the tendons which attach to joints) after the inflammatory phase has resolved. Heat also can be beneficial for headaches caused by muscle spasms in the neck.

Heat can be applied in a variety of ways: ready-made bags of buckwheat hulls that can be heated in a microwave, electric heating pads, heat lamps, hot water bottles, or muscle rubs that have a heating effect. As in the case with ice, skin should be protected from direct sources of heat.

When to Alternate Between the Two

The alternating use of hot and cold to treat injuries is known as contrast therapy. The theory behind contrast therapy is that the alternating vasodilation of heat with the vasoconstriction of cold creates a pumping effect that can reduce swelling. According to Paul Ingraham  on PainScience.com, he says that contrast therapy forces your tissues to adapt and is essentially an “extremely gentle tissue workout” that helps stimulate metabolic and circulatory activity while allowing that particular area of the body to rest.  The contrast between hot and cold is believed to also reduce pain.

The most common application of contrast therapy involves the use of cold water baths or whirlpools alternated with warm water baths or whirlpools with the timing of one to three minutes in cold water alternating with one to four minutes in warm water.

If you don’t have access to a professional training room with multiple whirlpool tubs, a kitchen sink (a double one works well), buckets or even towels all can be used for contrast therapy. Because of the difficulty of submerging certain body parts, a hip, for example, the extremities work best for contrast therapy. Conditions like plantar fasciitis, shin splits, Achilles tendinitis, carpal tunnel syndrome, tennis elbow, iliotibial band syndrome, and patellofemoral syndrome, all can respond to contrast therapy.

Ingraham also points out that contrast therapy may be more pleasant to use because it is relieving to cool down after you have been heated up and conversely, it feels good to heat up when you are cold. Contrast therapy may offer the best of both worlds.

Some Athletes Should Steer Clear

Those with general health problems like cardiovascular disease or low blood pressure probably shouldn’t undergo contrast therapy. Those with areas of the body that have decreased sensitivity to hot and/or cold, like diabetic neuropathy or Reynaud’s syndrome, should use all three therapies with caution. Exposure to extreme temperatures can burn the skin. The use of these therapies also is discouraged where there is an open wound or the presence of infection.


  1. Paul Ingraham, Contrast Hydrotherapy, web site
  2. Craig R. Denegar, PhD, ACT, PT, Ethan Saliba, Phd, ACT, PT and Susan Saliba, Phd, ACT, PT, How to Use Heat and Cold to Treat Athletic Injuries, web site/book excerpt
  3. Dr. Jan Sambrook, Heat and Ice Treatment for Pain, web site
  4. Cleveland Clinic Bone, Muscle and Joint Team, Should You Use Ice or Heat for Pain?, web site
  5. Ana Medaris Miller, Should You Try Whole Body Cryotherapy, web site

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