One of the most common confusions to face patients is whether they should be icing or heating after an injury.  Ice and heat therapy is a common at home self-care strategies that patients use, however, in order to receive the best benefit from your self-treatment it is good to know which treatment choice to use and when.

In order to decide which option is best for you it is important to understand that injuries fall into two general categories, acute injuries and chronic injuries.  Acute injuries are often a result of a trauma or impact, they are sudden and typically symptoms are short lived.  The most common symptoms involved in an acute injury are pain, swelling, redness, and skin that is warm to the touch.  A common example of an acute injury is a sprained ankle.  Chronic injuries, however, develop slowly and symptoms persist for a longer period of time, they are often a result of overuse and common symptoms include tightness, dull pain or soreness.  Also, acute injuries that aren’t properly treated may become chronic in nature.

The Quick and Dirty…..

  • New, re-aggravated, sharp pain, warm or swollen = ICE
  • Old, stiff, dull or achy pain = HEAT

The Nitty Gritty……

Ice is the best protocol for acute injuries because it reduces swelling and pain.  Ice should be used from the time of injury and for the next several days or as pain and/or swelling persists.  Icing is also a good at home treatment method for a chronic injury after each flare up.  For example if you have long standing knee pain that is aggravated each time you run, icing post run will help decrease pain and any swelling associated with the activity.  Some tips to keep in mind when icing include:

  • Ice should only be placed directly on the skin when the bag of ice has had all air removed, leaving a vacuum sealed appearance by sucking out the air. If this is difficult to create, place a very thin tea towel or paper towel that has been moistened against the skin and then the ice can be applied over that protective barrier.  Thick towels or dry material will not allow the transfer of cold into the tissue adequately.
  • Ice until the area just becomes numb – timing will differ depending on the area of the body, the size of the person etc. So listen to your body and apply until the area begins to feel numb.  Allow the area to warm to normal body temperature (compared to other side of the body for example) until you consider applying ice again.  You want all the benefits of the procedure, so allow your body to send all that nice fresh warm blood, full of nutrients to your injured tissue.  Any time after that, ice can be applied again.
  • Ice can and should be used several times per day

Ice for treatment

Heat is the best protocol for chronic injuries where no inflammation is present.  It is also a great at home treatment option for sore stiff muscles after a long day at work, say sitting at a desk in front of a computer.  Heat will bring blood flow to the area to help reduce muscle spasm and aid in the healing process.  Some tips to keep in mind when heating include:

  • Using a moist heat source such as a hot damp towel is always better than using a dry heat source. The moisture penetrates the tissue much better, providing a deeper, more significant effect.
  • Never apply heat directly to the skin, ensure that enough layers are present between the heat source and the skin to avoid burns
  • The greatest benefit of heat is delivered in the first 15-20 minutes. Prolonged heat applications can be detrimental to the tissue so be careful and never fall asleep with a heating apparatus applied.

Finally, alternating between ice and heat is a great at home treatment method for injuries that are in the sub acute phase, meaning they are more than a couple days old but less than a few weeks.  This protocol will help reduce swelling and increase the body’s healing mechanisms.  When using this protocol, use the application of heat and ice as described above, always allowing the tissue to return to normal temperature before applying the ice or heat.  Begin with heat and always end with an icing cycle.

Heating Pack

Although icing and heating are great at home strategies it is best to remember they are always more beneficial when used in conjunction with other treatment methods such as Athletic/Physio or Chiropractic therapy, soft tissue massage, stretching or mechanical corrections through exercise.


Stef Moser CAT(C)

Certified Athletic Therapist