Managing injuries with ice or heat

When faced with an injury or ache, many people wonder whether to use ice or heat. The information below is intended to help you make a more informed decision.


Ice should not be used directly on the skin or for longer than 20 minutes. You can buy reusable ice packs that can conform to the problem area, or you can always use a bag of frozen peas or corn as an inexpensive alternative.  Ice several times per day, but make sure the skin reaches room temperature before icing again.  You may have heard to ice for twenty minutes on then twenty minutes off and repeat.  This is very effective, but for many people, keeping track of this cycle can be too demanding, so I usually tell my patients to ice every hour on the hour for twenty minutes, which delivers similar results, but makes it much easier to keep track of time.  Acute injuries should be iced for three days.
Ice is what I recommend most often to my patients.  Ice is a vaso-constrictor, which means it causes the blood vessels to narrow and it limits internal bleeding at the injury site thus reducing swelling and pain.  Ice should be used on an acute condition, a pain caused by a sudden, sharp, or traumatic injury, like one caused by a fall or collision.  Ice can also be helpful for chronic or long term injuries that might not have had a clear cause.  For chronic injuries it is best to ice after activity. For example, if you have long term knee pain, you can ice it after a dance class.

Avoid using ice if you have high blood pressure, are elderly with thinning skin, have a vascular disorder like Raynaud’s, or if you are hypersensitive to cold.


Heat is generally used to treat chronic conditions or injuries when no inflammation or swelling is present.  Heat is ideal for treating pain caused by sore, achy, or stiff muscles or joints. Athletes with chronic pain or injuries often use heat therapy before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow. Heat can also help relax tight muscles or reduce muscle spasms.

Ice                                                                 Heat

20 minutes                                                      20 minutes

Acute Injury                                                     Chronic Injury

After exercise                                                  Before exercise


*Use both as part of a treatment plan with rest and corrective exercises

Apply heat for no longer than 20 minutes at a time.  To avoid burning yourself, have a towel between you and the heat source.  Do not fall asleep on a heating pack.  When possible, use moist heat.

Do not use heat if you have diabetes mellitus, active TB, encapsulated swellings, decreased thermal sensations, abdominal or low back pain during pregnancy, edema, or an acute condition especially if there is swelling.


Ice is a great first step to treating nearly any acute condition, particularly in the first 48-72 hours after symptoms appear.  It is an effective method to reduce inflammation and manage pain. Icing does however have its limitations.  If it is the only thing you do to treat the problem, it is not enough. Rest is an important part of the healing process, particularly with overuse injuries. Provided that nothing is broken, icing should be supplemented with non-weight bearing movement. After all, the main focus when addressing an acute condition should be on restoring proper functional movement, a task which is nearly impossible to achieve without actually moving.   So while icing itself cannot be overdone, it is certainly possible to develop an over reliance on icing, the effect of which will simply be slower recovery.

To see the full version, click here: Summer 2014