Ice vs Heat - What's Best?

Ice Versus Heat

Treating Your Injury Properly

-Dr. Andy Harmon, DC

Application of cold or hot therapy is common practice in sports medicine, however there seems to be some debate amongst coaches, parents, and players on whether to ice or heat for various types of injuries. Before discussing specifics, it's important to understand the basic reasons for applying ice or heat, respectively.


Ice application, also called cryotherapy, is primarily used to prevent or reduce inflammation and decrease pain. Inflammation is a protective attempt by the body to remove the injurious stimuli as well as initiate the healing process for the tissue. Inflammation can be classified as either acute or chronic.


Appying cold to an injury causes small vessels to constrict (known as vasoconstriction), limiting the amount of inflammation that builds up in the area. Cold therapy is also analgesic(pain relieving). The numbing effect of icing an injury can help relieve some of the immediate, irritating pain.


A classic example of applying cold therapy to an injury is when an athlete suffers an ankle sprain. Most of us have had this displeasure at some point in our lives. Most obviously, we feel pain which is accompanied by redness, swelling and warmth in the injured area. When an athlete suffers an ankle sprain, ligaments and tendons are torn and damaged. This alerts the body to send a cocktail of substances to the injury site to repair the injury. Ice is applied in the first 48 hours to minimize the swelling to the area. This ultimately results in faster healing, as measured by improved in range of motion, ability to re-build strength sooner, and earlier return to sports.


Heat application causes the vessels to open up (known as vasodilation). Heat application is appled when we want increased circulation to an area. This is more commonly used in cases of chronic injury, muscular tightness, and to warm up an area before participation in rehabilitation or sporting exercises. Heat also has analgesic effects, which is another reason why so many people love the whirlpool, steam room, or hot tub.


So When to Heat, and When to Ice?


Ice It

In general, all acute(new) musculoskeletal injuries should receive ice applications intermittently for the first 48 hours, and possibly longer. Fifteen to twenty(15-20) minutes of ice application every hour, 6-8 times per day for the first two days following an injury is a good guide. This, of course, also assumes that you have your injury evaluated by a sports injury specialist to confirm that the injury doesn't require further treatment.

Ice treatments may also be used for chronic conditions, such as overuse injuries in athletes. In this case, ice the injured area after activity to help control inflammation. This is demonstrated by pitchers icing their shoulders after every single outing. Never ice a chronic injury before activity.

Collegiate and Professional Pitchers routinely ice after each outing.

Heat It

Heat treatments should be used for chronic conditions to help relax and loosen tissues, and to stimulate blood flow to the area. Use heat treatments for chronic conditions, such as overuse injuries, before participating in activities.

Do not use heat treatments after activity, and do not use heat after an acute injury. Heating tissues can be accomplished using a heating pad, or even a hot, wet towel. When using heat treatments, be very careful to use a moderate heat for a limited time to avoid burns. Never leave heating pads on for extended periods of time, or use them while sleeping.

If an athlete is undergoing rehabilitation for an injury, and is no longer considered to be in the acute phase of injury(as indicated by your physician or therapist), heat may be recommended to to loosen the muscles before performing rehabilitation exercises. Ice is still often recommended after the activity to ensure that you did not cause re-injury and new inflammation to the area.


But Heat Feels So Good. . .


We frequently see patient's who have a new injury, and report that they just love to sit in the hot tub. This is relaxing, and it does feel good at the time. The problem is that the heat is encouraging more inflammation to arrive at the injured area. The result? It feels great while you're doing it, but you may wake up with more swelling, stiffness, and pain the next day. This is a good way to slow your overall healing timeline.


Why are we trying to stop the "inflammation" that the body sends to heal the injury?


That is a great question. The short answer: the body overreacts. Our bodies are great at sending a Blitzkrieg to an injured area. The body doesn't care how quickly an athlete can return to his or her sport. The body is designed to bring a strong response to an injury to make sure it is able to mend. It is proven that icing will not only decrease pain (which is a great idea) but it speeds the overall healing process.


So don't worry. By icing, you're not stopping your body from mending the damaged tissues. You're reducing the amount of time you spend hobbling around. By reducing inflammation immediately following a new injury, you are able to participate in rehabilitative exercise sooner, and get back to action sooner


The Bottom Line:


  1. Acute injuries (eg.. Ankle sprains)
  2. Chronic injuries after activity (eg. shin splints, tennis elbow)



1.  Chronic injuries before activity only


-Dr. Andy is a sports chiropractor in Boulder, CO who specializes in the diagnosis and management of soft tissue injuries. More information can be found at


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